Provider Demographics
NPI:1265743041
Name:MARRERO, DANIEL EDUARDO (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EDUARDO
Last Name:MARRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-8033
Mailing Address - Country:US
Mailing Address - Phone:860-679-2784
Mailing Address - Fax:860-679-3145
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-8033
Practice Address - Country:US
Practice Address - Phone:860-679-2784
Practice Address - Fax:860-679-3145
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT55062085R0202X
MA2534952085R0202X
CT0550062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology