Healthcare Provider Details

I. General information

NPI: 1790348423
Provider Name (Legal Business Name): KOKILA JEYAMURUGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OLD RUDNICK LN
DOVER DE
19901-4912
US

IV. Provider business mailing address

18 OLD RUDNICK LN
DOVER DE
19901-4912
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-2616
  • Fax:
Mailing address:
  • Phone: 302-674-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0024832
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: