Healthcare Provider Details

I. General information

NPI: 1902884463
Provider Name (Legal Business Name): PHILLIPH BIALECKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/05/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST
DOVER DE
19901-3530
US

IV. Provider business mailing address

640 S. STATE ST MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-6156
  • Fax: 302-735-3845
Mailing address:
  • Phone: 302-744-6156
  • Fax: 302-735-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC1-0027192
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: