Healthcare Provider Details

I. General information

NPI: 1437104866
Provider Name (Legal Business Name): DOVER PODIATRY GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 S STATE ST
DOVER DE
19901-4948
US

IV. Provider business mailing address

1418 S STATE ST
DOVER DE
19901-4948
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-7474
  • Fax: 302-674-4170
Mailing address:
  • Phone: 302-734-7474
  • Fax: 302-674-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1-0000062
License Number StateDE

VIII. Authorized Official

Name: DR. EDWARD J HYNES
Title or Position: OWNER/PRESIDENT
Credential: D.P.M.
Phone: 302-734-7474