Healthcare Provider Details

I. General information

NPI: 1467855254
Provider Name (Legal Business Name): KIDS AND TEENS PEDIATRICS OF DOVER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 S BRADFORD ST
DOVER DE
19904-4140
US

IV. Provider business mailing address

938 S BRADFORD ST
DOVER DE
19904-4140
US

V. Phone/Fax

Practice location:
  • Phone: 302-538-5624
  • Fax:
Mailing address:
  • Phone: 302-538-5624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics
License Number
License Number State

VIII. Authorized Official

Name: OSAMA A HUSSEIN
Title or Position: MD
Credential: MD
Phone: 302-538-5624