Healthcare Provider Details

I. General information

NPI: 1710981584
Provider Name (Legal Business Name): EDWARD J HYNES D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 11/06/2007
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:
Title or Position:
Credential:
Phone: