Provider Demographics
NPI:1700842135
Name:MONDERO, NANCY A (DO)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:MONDERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ANGLERS RD
Mailing Address - Street 2:UNIT 103
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1192
Mailing Address - Country:US
Mailing Address - Phone:302-644-9641
Mailing Address - Fax:302-827-4719
Practice Address - Street 1:110 ANGLERS RD
Practice Address - Street 2:UNIT 103
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1192
Practice Address - Country:US
Practice Address - Phone:302-644-9641
Practice Address - Fax:302-827-4719
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20005792207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001170903Medicaid
DE0001170903Medicaid