Active NPI
Ciriaco G. Bongalos, Jr., M.D.
- Internal Medicine Physician
- Dover, DE
National Provider Identifier
1174585954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- C10001931
- Practice address
- 1025 S Governors Ave
Dover, DE 19904-6901 - Phone
- (302) 734-9150
- Fax
- (302) 734-3931
- NPI assigned
- Apr 5, 2006
- Last updated
- Nov 24, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | C10001931 | DE | Primary |
Addresses
Primary practice location
1025 S Governors Ave
Dover, DE 19904-6901
Mailing address
1025 S Governors Ave
Dover, DE 19904-6901
Phone (302) 734-9150
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 26436 | Other | DE | COVENTRY HEALTH CARE |
| AETNA | Other | DE | 18151 |
| 0000088201 | Medicaid | DE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bayhealth Medical Center, Inc | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Bayhealth Physicians
- Colon & Rectal Surgery Physician
- Dover, DE
- NPI 1285809509
Internal Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259020800000",
"number": "1174585954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 S GOVERNORS AVE",
"city": "DOVER",
"state": "DE",
"postal_code": "199046901",
"telephone_number": "302-734-9150",
"fax_number": "302-734-3931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 S GOVERNORS AVE",
"city": "DOVER",
"state": "DE",
"postal_code": "199046901",
"telephone_number": "302-734-9150",
"fax_number": "302-734-3931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONGALOS, JR.",
"first_name": "CIRIACO",
"middle_name": "G.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-05",
"last_updated": "2009-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "DE",
"license": "C10001931",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY HEALTH CARE",
"identifier": "26436",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "18151",
"identifier": "AETNA",
"state": "DE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0000088201",
"state": "DE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dover, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.