Provider Demographics
NPI:1942283171
Name:TOBIN, DANIEL G (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:TOBIN
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 1:1450 CHAPEL ST
Mailing Address - Street 2:YALE PRIMARY CARE, SAINT RAPHAEL'S CAMPUS
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4405
Mailing Address - Country:US
Mailing Address - Phone:203-789-3989
Mailing Address - Fax:203-867-5608
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:YALE PRIMARY CARE, SAINT RAPHAEL'S CAMPUS
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-3989
Practice Address - Fax:203-867-5608
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001408667Medicaid
CT110008901Medicare ID - Type Unspecified
H71947Medicare UPIN