1992740906 NPI number — DELMARVA RADIATION SERVICES, PA

Table of content: (NPI 1992740906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992740906 NPI number — DELMARVA RADIATION SERVICES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELMARVA RADIATION SERVICES, 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:
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:
1992740906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 497
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958-0497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-645-3775
Provider Business Mailing Address Fax Number:
302-645-3774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18947 JOHN J WILLIAMS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REHOBOTH BEACH
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19971-4474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-645-3775
Provider Business Practice Location Address Fax Number:
302-645-3774
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COSTLEIGH
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEDICAL DIRECTOR/PRESIDENT
Authorized Official Telephone Number:
302-645-3775

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000038787 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE4449 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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