Healthcare Provider Details

I. General information

NPI: 1487742706
Provider Name (Legal Business Name): DAVID J POLIDORI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD MAP 2, SUITE 1201& 1205
NEWARK DE
19713-2072
US

IV. Provider business mailing address

PO BOX 30170
WILMINGTON DE
19805-7170
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1980
  • Fax: 302-733-1986
Mailing address:
  • Phone: 302-623-7365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC10007577
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberC10007577
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: