Healthcare Provider Details

I. General information

NPI: 1770765448
Provider Name (Legal Business Name): ELIZABETH REETZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH DEJEWSKI M.D.

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 FORREST AVE
DOVER DE
19904
US

IV. Provider business mailing address

2 PENNS WAY SUITE 412
NEW CASTLE DE
19720
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-2455
  • Fax: 302-322-6251
Mailing address:
  • Phone: 302-652-2455
  • Fax: 302-322-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0009928
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: