Healthcare Provider Details

I. General information

NPI: 1669660148
Provider Name (Legal Business Name): LOURDES L. CRUZ-FAGEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LOURDES C. FAGEL M.D.

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PEOPLES PLZ SUITE 301
NEWARK DE
19702-5707
US

IV. Provider business mailing address

1400 PEOPLES PLZ SUITE 301
NEWARK DE
19702-5707
US

V. Phone/Fax

Practice location:
  • Phone: 302-832-1560
  • Fax: 302-832-7450
Mailing address:
  • Phone: 302-832-1560
  • Fax: 302-832-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0007337
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: