Healthcare Provider Details

I. General information

NPI: 1164520573
Provider Name (Legal Business Name): CONSUELO C CAGANDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ SUITE 307
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

1 FEDERAL ST # 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2328
  • Fax: 856-541-6137
Mailing address:
  • Phone: 856-356-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD468901
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA076777
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier010777988 00
Identifier TypeOTHER
Identifier State
Identifier IssuerAMERICHOICE
# 2
Identifier44596
Identifier TypeOTHER
Identifier State
Identifier IssuerUNIVERSITY HEALTHPLAN
# 3
IdentifierP3722722
Identifier TypeOTHER
Identifier State
Identifier IssuerOXFORD
# 4
Identifier0115746
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 5
Identifier0428501
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 6
Identifier7362891
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 7
Identifier3K6034
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTHNET

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: