Healthcare Provider Details

I. General information

NPI: 1487488748
Provider Name (Legal Business Name): GARETH PEASE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST KENT CAMPUS, BAYHEALTH HOSPITAL
DOVER DE
19901
US

IV. Provider business mailing address

2539 ROSEMONT AVE
ARDMORE PA
19003-2623
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4700
  • Fax:
Mailing address:
  • Phone: 215-307-9251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012138
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: