Healthcare Provider Details

I. General information

NPI: 1881646164
Provider Name (Legal Business Name): MICHAEL CARUNCHIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 CHRISTIANA RD SUITE 201
NEWARK DE
19713-4236
US

IV. Provider business mailing address

774 CHRISTIANA RD SUITE 201
NEWARK DE
19713-4236
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-3017
  • Fax: 302-266-9960
Mailing address:
  • Phone: 302-731-3017
  • Fax: 302-266-9960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC1-0001986
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: