Healthcare Provider Details

I. General information

NPI: 1336174432
Provider Name (Legal Business Name): DELAWARE PODIATRIC MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 OLD RUDNICK LN
DOVER DE
19901-4912
US

IV. Provider business mailing address

22 OLD RUDNICK LN
DOVER DE
19901-4912
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-9255
  • Fax: 302-674-9096
Mailing address:
  • Phone: 302-674-9255
  • Fax: 302-674-9096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA HANLON
Title or Position: BILLING
Credential:
Phone: 302-674-9255