Healthcare Provider Details

I. General information

NPI: 1972501054
Provider Name (Legal Business Name): JOEL E CHODOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 OLD HARMONY RD. STE D
NEWARK DE
19713-4161
US

IV. Provider business mailing address

930 OLD HARMONY RD. STE D
NEWARK DE
19713-4161
US

V. Phone/Fax

Practice location:
  • Phone: 302-455-1980
  • Fax: 302-455-1999
Mailing address:
  • Phone: 302-455-1980
  • Fax: 302-455-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC10003147
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC1-0003147
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: