Healthcare Provider Details

I. General information

NPI: 1407874019
Provider Name (Legal Business Name): MATTHEW T CADDELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N DUPONT BLVD
MILFORD DE
19963-1019
US

IV. Provider business mailing address

800 N DUPONT BLVD
MILFORD DE
19963-1019
US

V. Phone/Fax

Practice location:
  • Phone: 302-672-2319
  • Fax: 302-430-5448
Mailing address:
  • Phone: 302-672-2319
  • Fax: 302-430-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number218076
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number218076-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0023888
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: