Provider Demographics
NPI:1255478624
Name:DARDER, MICHAEL CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:DARDER
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 1:2720 SHADOW RDG
Mailing Address - Street 2:
Mailing Address - City:KAMAS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-5031
Mailing Address - Country:US
Mailing Address - Phone:732-236-2339
Mailing Address - Fax:973-290-8370
Practice Address - Street 1:2720 SHADOW RDG
Practice Address - Street 2:
Practice Address - City:KAMAS
Practice Address - State:UT
Practice Address - Zip Code:84036-5031
Practice Address - Country:US
Practice Address - Phone:732-236-2339
Practice Address - Fax:973-290-8370
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04602200207VE0102X
NY162597207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD91529Medicare UPIN