1558440701 NPI number — DELAWARE CLINICAL & LABORATORY PHYSICIANS, PA

Table of content: (NPI 1558440701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558440701 NPI number — DELAWARE CLINICAL & LABORATORY PHYSICIANS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELAWARE CLINICAL & LABORATORY PHYSICIANS, PA
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:
HEM ONC DCLP
Provider Other Organization Name Type Code:
3
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:
1558440701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19850-2210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-454-9830
Provider Business Mailing Address Fax Number:
302-454-1445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4701 OGLETOWN STANTON RD
Provider Second Line Business Practice Location Address:
SUITE 4200
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713-2055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-454-9830
Provider Business Practice Location Address Fax Number:
302-454-1445
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WITKIN
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-454-9830

Provider Taxonomy Codes

  • Taxonomy code: 207RH0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 218202 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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