Provider Demographics
NPI:1265446934
Name:INGUITO, GALICANO FERNANDO JR (MD)
Entity Type:Individual
Prefix:
First Name:GALICANO
Middle Name:FERNANDO
Last Name:INGUITO
Suffix:JR
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 1:15 OMEGA DR
Mailing Address - Street 2:BUILDING K, SUITE # 3
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2057
Mailing Address - Country:US
Mailing Address - Phone:302-368-5003
Mailing Address - Fax:302-368-5595
Practice Address - Street 1:15 OMEGA DR
Practice Address - Street 2:BUILDING K, SUITE # 3
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2057
Practice Address - Country:US
Practice Address - Phone:302-368-5003
Practice Address - Fax:302-368-5595
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000844901OtherDELAWARE PHYSICIANS CARE
0313629000OtherAMERIHEALTH
2148OtherCOVENTRY
577489OtherAETNA US HEALTHCARE
863633OtherMAMSI
DEG58695OtherBCBS
DE0000844901Medicaid
G58695Medicare UPIN
2148OtherCOVENTRY
DE501490Medicare PIN