Provider Demographics
NPI:1831223700
Name:ARDAO, ALBERT DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:DANIEL
Last Name:ARDAO
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 1:292 PEQUOT AVE
Mailing Address - Street 2:#40
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320
Mailing Address - Country:US
Mailing Address - Phone:860-443-8098
Mailing Address - Fax:
Practice Address - Street 1:292 PEQUOT AVE
Practice Address - Street 2:#40
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-443-8098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028660208100000X
NY165617208100000X
PAMD 067735L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
B19210Medicare UPIN