Provider Demographics
NPI:1528209848
Name:MACHLEDER, DANIEL JACOB (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JACOB
Last Name:MACHLEDER
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 1:33 CHURCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1637
Mailing Address - Country:US
Mailing Address - Phone:203-426-5554
Mailing Address - Fax:203-426-7888
Practice Address - Street 1:1305 POST RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6016
Practice Address - Country:US
Practice Address - Phone:203-426-2926
Practice Address - Fax:203-292-6376
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602616522085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology