Healthcare Provider Details

I. General information

NPI: 1730127820
Provider Name (Legal Business Name): DELAWARE COASTAL ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S BAY RD STE 5B
DOVER DE
19901-4660
US

IV. Provider business mailing address

PO BOX 785802
PHILADELPHIA PA
19178-5802
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-4688
  • Fax: 302-678-4625
Mailing address:
  • Phone: 855-709-4535
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateDE

VIII. Authorized Official

Name: RODERICK M RELOVA
Title or Position: PARTNER/OWNER
Credential: D.O.
Phone: 302-331-4003