Provider Demographics
NPI:1447443676
Name:DARIA, ANTONIO JR (DO)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:DARIA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRUSHY PLAIN RD
Mailing Address - Street 2:SUITE 519
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405
Mailing Address - Country:US
Mailing Address - Phone:203-208-1041
Mailing Address - Fax:
Practice Address - Street 1:4 BRUSHY PLAIN RD
Practice Address - Street 2:SUITE 519
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-6000
Practice Address - Country:US
Practice Address - Phone:203-208-1041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001451517Medicaid
CTP00452767OtherRAILROAD MEDICARE
CT110010442Medicare PIN