Healthcare Provider Details

I. General information

NPI: 1649694027
Provider Name (Legal Business Name): UMS LITHOTRIPSY SERVICES OF KENT COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST
DOVER DE
19904-3485
US

IV. Provider business mailing address

1700 W PARK DR STE 410
WESTBOROUGH MA
01581-3939
US

V. Phone/Fax

Practice location:
  • Phone: 703-955-4923
  • Fax: 571-313-0262
Mailing address:
  • Phone: 703-955-4923
  • Fax: 571-313-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSANNE TALEBIAN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 703-955-4923