Healthcare Provider Details

I. General information

NPI: 1316032550
Provider Name (Legal Business Name): DELAWARE INSTITUTE OF PAIN MANAGEMENT &ANTI AGING MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E CAMDEN WYOMING AVE
CAMDEN DE
19934-1301
US

IV. Provider business mailing address

6 E CAMDEN WYOMING AVE
CAMDEN DE
19934-1301
US

V. Phone/Fax

Practice location:
  • Phone: 302-698-3994
  • Fax: 302-698-3952
Mailing address:
  • Phone: 302-698-3994
  • Fax: 302-698-3952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberC1-0005695
License Number StateDE

VIII. Authorized Official

Name: DR. NAZIM AMEER
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D
Phone: 302-359-3974