Healthcare Provider Details

I. General information

NPI: 1740239235
Provider Name (Legal Business Name): JOHN MATHEW CELLUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SLEEPY HOLLOW DR SUITE 100
MIDDLETOWN DE
19709-8894
US

IV. Provider business mailing address

8 PALMER DR
GLEN MILLS PA
19342-1288
US

V. Phone/Fax

Practice location:
  • Phone: 302-449-3100
  • Fax: 302-449-3110
Mailing address:
  • Phone: 610-558-1045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0004488
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: