Provider Demographics
NPI:1083688022
Name:TRINIDAD, ANTOLIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTOLIN
Middle Name:C
Last Name:TRINIDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 WEST ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6361
Mailing Address - Country:US
Mailing Address - Phone:203-791-5140
Mailing Address - Fax:203-798-8959
Practice Address - Street 1:152 WEST ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6361
Practice Address - Country:US
Practice Address - Phone:203-791-5140
Practice Address - Fax:203-798-9200
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD327862084P0800X
VA01010479012084P0800X
CT534982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010170613Medicaid
MD888500100Medicaid
DC025790700Medicaid