Healthcare Provider Details

I. General information

NPI: 1861449498
Provider Name (Legal Business Name): CNMRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 S BRADFORD ST
DOVER DE
19904-4141
US

IV. Provider business mailing address

1095 S BRADFORD ST
DOVER DE
19904-4141
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-8100
  • Fax:
Mailing address:
  • Phone: 302-678-8100
  • Fax: 888-990-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC10002687
License Number StateDE

VIII. Authorized Official

Name: MRS. AUDREY A LENOX
Title or Position: PRACTICE MANAGER
Credential:
Phone: 302-346-2491