Provider Demographics
NPI:1407874019
Name:CADDELL, MATTHEW T (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:T
Last Name:CADDELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1019
Mailing Address - Country:US
Mailing Address - Phone:302-672-2319
Mailing Address - Fax:302-430-5448
Practice Address - Street 1:800 N DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1019
Practice Address - Country:US
Practice Address - Phone:302-672-2319
Practice Address - Fax:302-430-5448
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2180762083P0500X
NY218076-12083X0100X
DEC2-0023888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02444484Medicaid
NY5016G1OtherEMPIRE BC.BS
NY7132503OtherAETNA
DE1T6630OtherMEDICARE PTAN
NY7132503OtherAETNA
NY02444484Medicaid