Individual provider Active NPI

Mary Virginia Iacocca, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Newark, DE
National Provider Identifier
1689670119
Registry record updated Mar 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
C10006014 Issued in DE
Practice address
4755 Ogletown Stanton Rd
Newark, DE 19718-6001
Phone
(302) 454-9830
Fax
(302) 454-1445
NPI assigned
Jun 21, 2005
Last updated
Mar 9, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X C10006014 DE Primary

Addresses

Primary practice location

4755 Ogletown Stanton Rd
Newark, DE 19718-6001

Mailing address

PO Box 12210
Wilmington, DE 19850-2210
Phone (302) 454-9830

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
I20110616000628 DE Practitioner - Pathology 2466531314 Reassigns benefits to 2 organizations
I20260616004839 MD Practitioner - Pathology 2466531314 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Virginia Commonwealth University, School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christiana Care Health Services IncGroup PAC ID 9739097569, shared by 25 NPIs, 1,480 clinicians

Practice addresses (Care Compare)

4701 Ogletown Stanton Rd
Suite 4200
Newark, DE 19713-2075
Phone (302) 737-7700

4755 Ogletown Stanton Rd
Newark, DE 19718-2200
Phone (302) 733-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C10006014DEMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services, Inc Anatomic Pathology & Clinical Pathology CurrentSince Jan 11, 2021 Accepting new patients
Christiana Care Health Services, Inc Current Accepting new patients
Christiana Care Health Services Inc CurrentSince Jan 11, 2021 Accepting new patients
Christiana Care Health Services, Inc CurrentSince Jan 11, 2021 Accepting new patients

Locations

200 Hygeia Dr
Newark, DE 19713
Phone (302) 273-1701

4701 Ogletown Stanton Rd
Ste 4200
Newark, DE 19713
Phone (302) 658-7533

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

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

501 W 14th St
Wilmington, DE 19801
Phone (302) 320-4411

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299628800000",
    "number": "1689670119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12210",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198502210",
            "telephone_number": "302-454-9830",
            "fax_number": "302-454-1445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197186001",
            "telephone_number": "302-454-9830",
            "fax_number": "302-454-1445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IACOCCA",
        "first_name": "MARY",
        "middle_name": "VIRGINIA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-21",
        "last_updated": "2011-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "DE",
            "license": "C10006014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.