Healthcare Provider Details

I. General information

NPI: 1003842436
Provider Name (Legal Business Name): LYNDON B CAGAMPAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST STE 350
DOVER DE
19904-3485
US

IV. Provider business mailing address

200 BANNING ST STE 350
DOVER DE
19904-3485
US

V. Phone/Fax

Practice location:
  • Phone: 302-730-8848
  • Fax: 302-730-8846
Mailing address:
  • Phone: 302-730-8848
  • Fax: 302-730-8846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberC10007996
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: