Individual provider Active NPI

Mikael Fadoul, MD

  • Vascular Surgery Physician
  • Newark, DE
National Provider Identifier
1053974824
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
C1-0027330 Issued in DE
Practice address
4755 Ogletown Stanton Rd Ste 1E20
Newark, DE 19718-2200
Phone
(302) 733-5700
Fax
(302) 733-5775
NPI assigned
Apr 17, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X C1-0027330 DE Primary

Addresses

Primary practice location

4755 Ogletown Stanton Rd Ste 1E20
Newark, DE 19718-2200

Mailing address

4755 Ogletown Stanton Rd Ste 1E20
Newark, DE 19718-2200
Phone (302) 733-5700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE, MD2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240910000740 DE Practitioner - Vascular Surgery 8022558667 Reassigns benefits to 2 organizations
I20240912001862 MD Practitioner - Vascular Surgery 8022558667 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Temple University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Union Hospital of Cecil CountyGroup PAC ID 6901719822, 281 clinicians
Christiana Care Health Services IncGroup PAC ID 9739097569, shared by 25 NPIs, 1,480 clinicians

Practice addresses (Care Compare)

106 Bow St
Elkton, MD 21921-5544
Phone (410) 398-4000

4755 Ogletown Stanton Rd
Newark, DE 19718-2200

Hospital & facility affiliations

  • Christianacare Homehealth Home health agency, Wilmington, DE, CCN 087002
  • Christiana Hospital Hospital, Newark, DE, CCN 080001
  • Union Hospital of Cecil County Hospital, Elkton, MD, CCN 210032
  • Bayhealth Medical Center, Kent Campus Hospital, Dover, DE, CCN 080004

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Leg revascularization (restoring blood flow)35
Removal of tissue15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C1-0027330DEMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services, Inc Current Accepting new patients
Christiana Care Health Services Inc CurrentSince Aug 27, 2024 Accepting new patients
Christiana Care Health Services Inc Vascular Surgery CurrentSince Aug 27, 2024 Accepting new patients
Union Hospital of Cecil County, Inc. CurrentSince Sep 15, 2024 Accepting new patients
Christiana Care Health Services Inc Vascular Surgery CurrentSince Aug 27, 2024 Accepting new patients
Union Hospital of Cecil County CurrentSince Sep 15, 2024 Accepting new patients
Christiana Care Health Services, Inc Past Accepting new patients
Vascular Consultants PA Vascular Surgery PastSince Aug 1, 2024 Accepting new patients

Locations

4755 Ogletown Stanton Rd
Newark, DE 19718
Phone (302) 733-1700

4755 Ogletown Stanton Rd
Ste 1E20
Newark, DE 19718
Phone (302) 733-5625

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

123 Singerly Ave
Elkton, MD 21921
Phone (410) 392-2686

111 W High St
Ste 207
Elkton, MD 21921
Phone (410) 398-3950

106 Bow St
Elkton, MD 21921
Phone (410) 298-2000

207 North St
Ste A
Elkton, MD 21921

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1053974824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD STE 1E20",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-733-5700",
            "fax_number": "302-733-5775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD STE 1E20",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-733-5700",
            "fax_number": "302-733-5775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADOUL",
        "first_name": "MIKAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-17",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "DE",
            "license": "C1-0027330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.