Healthcare Provider Details

I. General information

NPI: 1730180696
Provider Name (Legal Business Name): VINCENT E SCHALLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5936 LIMESTONE RD STE 301B
HOCKESSIN DE
19707-8930
US

IV. Provider business mailing address

1205 KINTERRA CT
WEST CHESTER PA
19382-6976
US

V. Phone/Fax

Practice location:
  • Phone: 302-234-4000
  • Fax: 302-234-4315
Mailing address:
  • Phone: 302-235-8808
  • Fax: 302-235-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC10004737
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD425156
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC10004737
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: