Healthcare Provider Details

I. General information

NPI: 1568803575
Provider Name (Legal Business Name): HARESH SAMPATHKUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 COLLEGE PARK DR STE 203
DOVER DE
19904-8727
US

IV. Provider business mailing address

1221 COLLEGE PARK DR STE 203
DOVER DE
19904-8727
US

V. Phone/Fax

Practice location:
  • Phone: 302-387-1407
  • Fax: 877-381-4173
Mailing address:
  • Phone: 302-387-1407
  • Fax: 877-381-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License NumberC1-0013194
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberC1-0013194
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: