Organization
NANTICOKE GASTROENTEROLOGY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY PAUL MACKLER M.D. (C.E.O.)
(302) 629-2229
Entity
Organization
Contact information
Practice address
924 MIDDLEFORD RD, SEAFORD, DE 19973-3604
(302) 629-2229
(302) 629-2285
Mailing address
924 MIDDLEFORD RD, SEAFORD, DE 19973-3604
(302) 629-2229
(302) 629-2285
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
C10004336
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000825302
—
DE
01
—
085567809
CHAMPUS
DE
01
—
0916029 00
MARYLAND MEDICAID
MD
01
—
100010338
MEDICARE RAILROAD
DE
01
—
1939
COVENTRY
DE
01
—
2714
CAREFIRST
DE
01
—
421862
OPT CHOICE
DE
01
—
505182
AETNA
DE
01
—
PAL58270210001
CIGNA HEALTHCARE
DE
01
—
T266
BLUECROSS
DE
Enumeration date
02/08/2007
Last updated
03/14/2012
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