Provider Demographics
NPI:1104875400
Name:DELEON, MIGUEL L (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:L
Last Name:DELEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:1935 ROUTE 70 E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2117
Practice Address - Country:US
Practice Address - Phone:856-428-7700
Practice Address - Fax:856-424-9120
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2024-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04250400208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2200406Medicaid
NJ051032A7TMedicare PIN
NJ2200406Medicaid