Provider Demographics
NPI:1891874376
Name:DADDARIO, PETER FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:FRANCIS
Last Name:DADDARIO
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 1:25 NEWELL RD STE D21
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5128
Mailing Address - Country:US
Mailing Address - Phone:860-585-6944
Mailing Address - Fax:860-585-7746
Practice Address - Street 1:25 NEWELL RD STE D21
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-585-6944
Practice Address - Fax:860-585-7746
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT029024208800000X
CT029024208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
010029024CT03OtherANTHEM BLUE CROSS
340000156Medicare ID - Type Unspecified
F29023Medicare UPIN