Healthcare Provider Details

I. General information

NPI: 1255478624
Provider Name (Legal Business Name): MICHAEL CHARLES DARDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 SHADOW RDG
KAMAS UT
84036-5031
US

IV. Provider business mailing address

2720 SHADOW RDG
KAMAS UT
84036-5031
US

V. Phone/Fax

Practice location:
  • Phone: 732-236-2339
  • Fax: 973-290-8370
Mailing address:
  • Phone: 732-236-2339
  • Fax: 973-290-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number25MA04602200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number162597
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: