Healthcare Provider Details

I. General information

NPI: 1649226200
Provider Name (Legal Business Name): INTEGRATED CARE OF DOVER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 GOODEN AVE
DOVER DE
19904-4143
US

IV. Provider business mailing address

29 GOODEN AVE
DOVER DE
19904-4143
US

V. Phone/Fax

Practice location:
  • Phone: 302-735-7780
  • Fax: 302-735-7781
Mailing address:
  • Phone: 302-735-7780
  • Fax: 302-735-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0005394
License Number StateDE

VIII. Authorized Official

Name: DR. DAVID GARCIA REYES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 302-735-7780