Healthcare Provider Details

I. General information

NPI: 1174528772
Provider Name (Legal Business Name): PRENTISS WAYNE ADKINS SR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29475 VINES CREEK RD
DAGSBORO DE
19939-3839
US

IV. Provider business mailing address

29475 VINES CREEK RD
DAGSBORO DE
19939-3839
US

V. Phone/Fax

Practice location:
  • Phone: 302-732-9593
  • Fax: 302-732-9598
Mailing address:
  • Phone: 302-732-9593
  • Fax: 302-732-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberC2-0002872
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: