Healthcare Provider Details

I. General information

NPI: 1053612804
Provider Name (Legal Business Name): HENRY U. ISIOCHA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177B S GOVERNORS AVE
DOVER DE
19904-6903
US

IV. Provider business mailing address

1177B S GOVERNORS AVE
DOVER DE
19904-6903
US

V. Phone/Fax

Practice location:
  • Phone: 302-747-7903
  • Fax: 302-747-7906
Mailing address:
  • Phone: 302-747-7903
  • Fax: 302-747-7906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberC1-0005027
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberC1-0005027
License Number StateDE

VIII. Authorized Official

Name: HENRY U ISIOCHA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 302-747-7903