Healthcare Provider Details

I. General information

NPI: 1376106948
Provider Name (Legal Business Name): KYLA-GAYE PINNOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 07/26/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S QUEEN ST
DOVER DE
19904-3567
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 302-734-7834
  • Fax: 302-734-7847
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0025011
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: