Healthcare Provider Details

I. General information

NPI: 1306829189
Provider Name (Legal Business Name): DARRELL W CARPENTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 S NEW ST
DOVER DE
19904-3540
US

IV. Provider business mailing address

640 S STATE ST BLDG 742
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4070
  • Fax: 302-672-2315
Mailing address:
  • Phone: 302-674-3970
  • Fax: 302-674-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number229066
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC1-0010848
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0075452
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: