Healthcare Provider Details

I. General information

NPI: 1932454618
Provider Name (Legal Business Name): CNMRI PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 S BRADFORD ST
DOVER DE
19904-4141
US

IV. Provider business mailing address

1074 S STATE ST
DOVER DE
19901-6925
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-8100
  • Fax:
Mailing address:
  • Phone: 302-678-8100
  • Fax: 302-346-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY RUST
Title or Position: BILLING CLERK
Credential:
Phone: 302-346-2491