Healthcare Provider Details

I. General information

NPI: 1740863794
Provider Name (Legal Business Name): THOMAS CHARLES MARCONI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON ROAD
NEWARK DE
19178
US

IV. Provider business mailing address

4755 OGLETOWN STANTON ROAD
NEWARK DE
19178
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1840
  • Fax:
Mailing address:
  • Phone: 302-733-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0029486
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC1-0029486
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0106800
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0106800
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: