Healthcare Provider Details

I. General information

NPI: 1932146255
Provider Name (Legal Business Name): MARC J LAUFGRABEN MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD MAP 2 STE 3201
NEWARK DE
19713-2094
US

IV. Provider business mailing address

200 HYGEIA DR STE 2300
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4323
  • Fax: 856-968-0735
Mailing address:
  • Phone: 856-342-2312
  • Fax: 856-968-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA08922800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD09982
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberC10012170
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: