Active NPI
Constantine W. Michell, D.O.
- Family Medicine Physician
- Newark, DE
National Provider Identifier
1558368035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- C2-0000333
- Practice address
- 89 Omega Dr
Newark, DE 19713-2065 - Phone
- (302) 738-5500
- Fax
- (302) 738-9449
- NPI assigned
- Jun 30, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C2-0000333 | DE | Primary |
Addresses
Primary practice location
89 Omega Dr
Newark, DE 19713-2065
Mailing address
1320 Philadelphia Pike
Wilmington, DE 19809-1818
Phone (302) 738-5500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000132803 | 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)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C2-0000333 | DE | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Koniver Fiss Mansoory MD PA | 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 and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Wilmington, DE
- NPI 1083615561
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187827200000",
"number": "1558368035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1320 PHILADELPHIA PIKE",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198091818",
"telephone_number": "302-738-5500",
"fax_number": "302-738-9449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "89 OMEGA DR",
"city": "NEWARK",
"state": "DE",
"postal_code": "197132065",
"telephone_number": "302-738-5500",
"fax_number": "302-738-9449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICHELL",
"first_name": "CONSTANTINE",
"middle_name": "W.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-30",
"last_updated": "2007-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "DE",
"license": "C2-0000333",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0000132803",
"state": "DE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newark, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.