Healthcare Provider Details

I. General information

NPI: 1295808590
Provider Name (Legal Business Name): ENT & FACIAL PLASTIC SURGERY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 S GOVERNORS AVE
DOVER DE
19904-4107
US

IV. Provider business mailing address

826 S GOVERNORS AVE
DOVER DE
19904-4107
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-3752
  • Fax: 302-674-8521
Mailing address:
  • Phone: 302-674-3752
  • Fax: 302-674-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberC10002552
License Number StateDE

VIII. Authorized Official

Name: DR. STEPHEN G COOPER
Title or Position: PRESIDENT
Credential: M.D.,
Phone: 302-674-3752