Healthcare Provider Details

I. General information

NPI: 1982594354
Provider Name (Legal Business Name): OBDIEL DORMELUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E GROVE ST
DELMAR DE
19940-1117
US

IV. Provider business mailing address

323 PARK AVE APT 3
SALISBURY MD
21801-4217
US

V. Phone/Fax

Practice location:
  • Phone: 334-498-2319
  • Fax:
Mailing address:
  • Phone: 334-498-2319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: