Healthcare Provider Details

I. General information

NPI: 1396159182
Provider Name (Legal Business Name): CHRISTOPHER CHARLES PRIETO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON ROAD SUITE 5A43
NEWARK DE
19718-2200
US

IV. Provider business mailing address

200 HYGEIA DR STE 2300
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-0188
  • Fax: 215-612-4069
Mailing address:
  • Phone: 215-612-5161
  • Fax: 215-612-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC2-0012196
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: