Provider Demographics
NPI:1043479090
Name:BOXER, DANIEL ETHAN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ETHAN
Last Name:BOXER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 CEDAR STREET, YALE MEDICAL SCHOOL
Mailing Address - Street 2:WWW205
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510
Mailing Address - Country:US
Mailing Address - Phone:203-845-4811
Mailing Address - Fax:203-845-4897
Practice Address - Street 1:5520 PARK AVENUE
Practice Address - Street 2:GARDEN LEVEL
Practice Address - City:TRUMBALL
Practice Address - State:CT
Practice Address - Zip Code:06611
Practice Address - Country:US
Practice Address - Phone:203-502-8400
Practice Address - Fax:203-845-4897
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT56291207RH0003X, 207RH0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00773616OtherRAILROAD MEDICARE
DCP00773616OtherRAILROAD MEDICARE