Healthcare Provider Details

I. General information

NPI: 1821527060
Provider Name (Legal Business Name): DIEGO URDANETA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2017
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N BROAD ST
PHILADELPHIA PA
19102-1121
US

IV. Provider business mailing address

700 MULLICA HILL RD
MULLICA HILL NJ
08062-4413
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-7000
  • Fax:
Mailing address:
  • Phone: 856-508-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT214037
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA11091000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: