Provider Demographics
NPI:1780707281
Name:MIRRO, DANIEL PETER (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PETER
Last Name:MIRRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:999 ROUTE 73 N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1227
Mailing Address - Country:US
Mailing Address - Phone:856-802-6888
Mailing Address - Fax:856-802-6878
Practice Address - Street 1:999 ROUTE 73 N
Practice Address - Street 2:SUITE 200
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1227
Practice Address - Country:US
Practice Address - Phone:856-802-6888
Practice Address - Fax:856-802-6878
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA024860002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry