Provider Demographics
NPI:1134301179
Name:DICAPUA, DANIEL BRYANT (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BRYANT
Last Name:DICAPUA
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 1:7 MOUNTAIN VIEW COURT
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478
Mailing Address - Country:US
Mailing Address - Phone:203-640-7138
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:T-209
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-785-4085
Practice Address - Fax:203-785-4937
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT390200000X2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology