Provider Demographics
NPI:1639339484
Name:DUFFALO, CHAD (MD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:DUFFALO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHAD
Other - Middle Name:
Other - Last Name:DUFFALO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:537 STANTON CHRISTIANA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2146
Mailing Address - Country:US
Mailing Address - Phone:302-994-9692
Mailing Address - Fax:302-994-9803
Practice Address - Street 1:537 STANTON CHRISTIANA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2146
Practice Address - Country:US
Practice Address - Phone:302-994-9692
Practice Address - Fax:302-994-9803
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA247974207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE324289I60Medicare PIN
MA002775403Medicare PIN