Healthcare Provider Details

I. General information

NPI: 1467806711
Provider Name (Legal Business Name): REGIONAL MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 BEISER BLVD SUITE 201
DOVER DE
19904-8208
US

IV. Provider business mailing address

240 BEISER BLVD SUITE 201
DOVER DE
19904-8208
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-7246
  • Fax:
Mailing address:
  • Phone: 302-734-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2016602500
License Number StateDE

VIII. Authorized Official

Name: DR. GANESH R BALU
Title or Position: PRESIDENT
Credential: MD
Phone: 302-734-7246