1740235449 NPI number — CHRISTIANA CENTER FOR ORAL & MAXILLOFACIAL SURGERY, P.A.

Table of content: (NPI 1740235449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740235449 NPI number — CHRISTIANA CENTER FOR ORAL & MAXILLOFACIAL SURGERY, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTIANA CENTER FOR ORAL & MAXILLOFACIAL SURGERY, P.A.
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:
Provider Other Organization Name Type Code:
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:
1740235449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4133 STANTON OGLETWN RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713-4187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-292-1600
Provider Business Mailing Address Fax Number:
302-319-5954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4133 OGLETOWN STANTON RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713-4187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
130-232-8677
Provider Business Practice Location Address Fax Number:
23-195-9543
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAMICO
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-292-1600

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  G1-0000952 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000540991 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000189002 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4300241 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 199367325 . This is a "CAREFIRST BLUE CROSS BLUE SHIELD OF DELAWARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0116093000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com