Healthcare Provider Details

I. General information

NPI: 1912215542
Provider Name (Legal Business Name): DELAWARE PLASTIC SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST SUITE 230
DOVER DE
19904-3485
US

IV. Provider business mailing address

200 BANNING ST SUITE 230
DOVER DE
19904-3485
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4865
  • Fax:
Mailing address:
  • Phone: 302-674-4865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberC1-0005640
License Number StateDE

VIII. Authorized Official

Name: DR. DAVID E SCHMIDT JR.
Title or Position: SURGEON
Credential: M.D.
Phone: 302-674-4865