Provider Demographics
NPI:1124028808
Name:MAGED, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:MAGED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 LIMESTONE RD
Mailing Address - Street 2:STE 301
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2147
Mailing Address - Country:US
Mailing Address - Phone:302-633-1700
Mailing Address - Fax:302-633-4418
Practice Address - Street 1:3105 LIMESTONE RD
Practice Address - Street 2:STE 301
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2147
Practice Address - Country:US
Practice Address - Phone:302-633-1700
Practice Address - Fax:302-633-4418
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003054207R00000X
DEC1-0003054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE62101Medicaid
DE115006I71OtherMEDICARE PTAN
DE62101Medicaid