Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 021446 | DE |
NPI | 1003881426 |
---|---|
Provider Name | Thomas J. Danyliw |
First Address | Middletown, CT 06457-3654 |
Second Address | Middletown, CT 06457-3654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E 09021 | (02) | CT |