Provider Demographics
NPI:1447340179
Name:MARCHILDON, MICHAEL B (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:MARCHILDON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:VIRTUA AND DUPONT CHILDRENS HEALTH PROGRAM
Practice Address - Street 2:1000 WHITE HORSE ROAD SUITE 204
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4406
Practice Address - Country:US
Practice Address - Phone:856-309-8508
Practice Address - Fax:856-309-8556
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-09-29
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Provider Licenses
StateLicense IDTaxonomies
NJMA039033002086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3716708Medicaid
MD4881036Medicaid
PA1176902Medicaid
PA1176902Medicaid
0443528ROTMedicare PIN