1538372750 NPI number — DYNAMIC THERAPEUTICS INC.

Table of content: (NPI 1538372750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538372750 NPI number — DYNAMIC THERAPEUTICS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC THERAPEUTICS INC.
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:
6
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:
1538372750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
819 CHURCHMANS ROAD EXT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19720-3152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-322-3304
Provider Business Mailing Address Fax Number:
302-322-3306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
819 CHURCHMANS ROAD EXT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19720-3152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-322-3304
Provider Business Practice Location Address Fax Number:
302-322-3306
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHANDLER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-322-3304

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  F1-0000435 , 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: 0529674000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2122380 . This is a "MAMSI/OPTIMA CHOICE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 409623 . This is a "COVENTRY" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2219986 . This is a "AETNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2276361 . This is a "FIRST HEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0529674000 . This is a "AMERIHEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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