1730127820 NPI number — DELAWARE COASTAL ANESTHESIA LLC

Table of content: (NPI 1730127820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730127820 NPI number — DELAWARE COASTAL ANESTHESIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELAWARE COASTAL ANESTHESIA LLC
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:
1730127820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 785802
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-5802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-709-4535
Provider Business Mailing Address Fax Number:
302-733-0854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 S BAY RD
Provider Second Line Business Practice Location Address:
STE 5B
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19901-4660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-678-4688
Provider Business Practice Location Address Fax Number:
302-678-4625
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RELOVA
Authorized Official First Name:
RODERICK
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PARTNER/OWNER
Authorized Official Telephone Number:
302-331-4003

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , 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: 1000028581 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB7759 . This is a "RAILROAD" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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