Provider Demographics
NPI:1932110418
Name:CHIN, DANIEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:CHIN
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 1:1166 FARMINGTON AVE.
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2302
Mailing Address - Country:US
Mailing Address - Phone:860-829-8939
Mailing Address - Fax:860-829-8938
Practice Address - Street 1:1166 FARMINGTON AVE.
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-2302
Practice Address - Country:US
Practice Address - Phone:860-829-8939
Practice Address - Fax:860-829-8938
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026232207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001262328Medicaid
B37769Medicare UPIN
CT001262328Medicaid
CT180000949Medicare ID - Type Unspecified