Healthcare Provider Details

I. General information

NPI: 1720775737
Provider Name (Legal Business Name): DANIEL G MOODEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD STE 5A43
NEWARK DE
19718-2200
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-0188
  • Fax: 302-733-5640
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC2-0025017
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB12946500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: