Healthcare Provider Details

I. General information

NPI: 1407998040
Provider Name (Legal Business Name): CONSTANTINE AZARCON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 SILVERSIDE ROAD, RODNEY BUILDING SUITE 107
WILMINGTON DE
19810
US

IV. Provider business mailing address

3411 SILVERSIDE ROAD, RODNEY BUILDING SUITE 107
WILMINGTON DE
19810-3540
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-2969
  • Fax: 302-351-4031
Mailing address:
  • Phone: 302-478-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC1-0006767
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: