Provider Demographics
NPI:1083668628
Name:SICA, DANIEL G (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:SICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4552
Mailing Address - Country:US
Mailing Address - Phone:203-459-0408
Mailing Address - Fax:203-459-0410
Practice Address - Street 1:888 WHITE PLAINS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4552
Practice Address - Country:US
Practice Address - Phone:203-459-0408
Practice Address - Fax:203-459-0410
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT025730207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001257302Medicaid
COB38693Medicare UPIN
CT110006321Medicare ID - Type Unspecified