Provider Demographics
NPI:1346532017
Name:FACCIOLO, GINA MARIE (D O)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:FACCIOLO
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:CAPITONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DRIVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-623-5770
Mailing Address - Fax:302-234-5777
Practice Address - Street 1:726 YORKLYN ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8745
Practice Address - Country:US
Practice Address - Phone:302-623-5770
Practice Address - Fax:302-234-5777
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC-0004804207Q00000X
DEC2-0010405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine