Provider Demographics
NPI:1477661510
Name:CHILTON, DANIEL REYNOLDS (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:REYNOLDS
Last Name:CHILTON
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 1:259 ALBANY TPKE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2557
Mailing Address - Country:US
Mailing Address - Phone:860-693-4307
Mailing Address - Fax:
Practice Address - Street 1:259 ALBANY TPKE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2557
Practice Address - Country:US
Practice Address - Phone:860-693-4307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB38702Medicare UPIN
CT080000165Medicare ID - Type Unspecified