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General NPI Number Information
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NPI Number | 1649311325
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Entity Type | Organization
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Legal Business Name | NANTICOKE GASTROENTEROLOGY, P.A.
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 924 MIDDLEFORD RD
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City | SEAFORD
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State | DE
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Zip | 19973-3604
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Country | US
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Telephone | 302-629-2229
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Fax | 302-629-2285
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Provider Business Mailing Address
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Address Line | 924 MIDDLEFORD RD
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City | SEAFORD
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State | DE
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Zip | 19973-3604
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Country | US
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Telephone | 302-629-2229
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Fax | 302-629-2285
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. BRADLEY PAUL MACKLER
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Credential | M.D.
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Telephone | 302-629-2229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | C10004336
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License Number State | DE
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