1720029978 NPI number — WOMEN'S IMAGING CENTER OF DELAWARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720029978 NPI number — WOMEN'S IMAGING CENTER OF DELAWARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN'S IMAGING CENTER OF DELAWARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERICAN OB/GYN
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720029978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
OMEGA DRIVE J
Provider Second Line Business Mailing Address:
24
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-738-9100
Provider Business Mailing Address Fax Number:
302-292-0204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OMEGA DRIVE
Provider Second Line Business Practice Location Address:
BUILDING J SUITE 24
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-738-9100
Provider Business Practice Location Address Fax Number:
302-292-0204
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EDELL
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
302-738-6202

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  C2001719 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: C10005116 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: C20005963 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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