Healthcare Provider Details

I. General information

NPI: 1467076059
Provider Name (Legal Business Name): STELLAR SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BEISER BLVD STE 200
DOVER DE
19904-7792
US

IV. Provider business mailing address

142 GLENDA RD
DOVER DE
19901-4922
US

V. Phone/Fax

Practice location:
  • Phone: 302-505-0045
  • Fax: 888-873-9653
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LOUIS E COSTA
Title or Position: OWNER
Credential: DO
Phone: 302-505-0045