Healthcare Provider Details

I. General information

NPI: 1467639864
Provider Name (Legal Business Name): JAGDEEP SINGH HUNDAL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PRIDES XING STE 200
NEWARK DE
19713-6109
US

IV. Provider business mailing address

1011 POWELL CT
BEAR DE
19701-4949
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-0300
  • Fax: 302-543-8456
Mailing address:
  • Phone: 302-836-8961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD0066022
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC1-0008440
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: