Healthcare Provider Details

I. General information

NPI: 1154476190
Provider Name (Legal Business Name): MARK G CADUNGOG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD STE 2335
NEWARK DE
19713-7016
US

IV. Provider business mailing address

200 HYGEIA DR
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4285
  • Fax: 302-623-4155
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT186498
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberC1-0008694
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: