Healthcare Provider Details

I. General information

NPI: 1649523697
Provider Name (Legal Business Name): ERANGA CARDIOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST STE 310
DOVER DE
19904-3488
US

IV. Provider business mailing address

200 BANNING ST STE 310
DOVER DE
19904-3488
US

V. Phone/Fax

Practice location:
  • Phone: 302-747-7486
  • Fax: 302-747-7691
Mailing address:
  • Phone: 302-747-7486
  • Fax: 302-747-7691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ERANGA HATHTHOTUWA
Title or Position: OWNER
Credential: MD
Phone: 302-747-7486