Provider Demographics
NPI:1730106279
Name:KELLNER, DANIEL S (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:KELLNER
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 1:789 HOWARD AVE
Mailing Address - Street 2:PO BOX 208058, FITKIN 300
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1304
Mailing Address - Country:US
Mailing Address - Phone:203-737-7620
Mailing Address - Fax:203-737-4043
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:SUITE 164
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-785-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042946208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I31227Medicare UPIN
340000379Medicare ID - Type Unspecified