Healthcare Provider Details

I. General information

NPI: 1689906109
Provider Name (Legal Business Name): DOVER OB-GYN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SAULSBURY RD
DOVER DE
19904-3444
US

IV. Provider business mailing address

21 SAULSBURY RD
DOVER DE
19904-3444
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-9200
  • Fax: 302-730-8615
Mailing address:
  • Phone: 302-734-9200
  • Fax: 302-730-8615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberC200008667
License Number StateDE

VIII. Authorized Official

Name: ALTON A TROTT
Title or Position: OWNER/OPERATOR
Credential: D.O.
Phone: 302-734-9200