Healthcare Provider Details

I. General information

NPI: 1851459200
Provider Name (Legal Business Name): ROBERT WARREN WILTSHIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SAVANNAH RD
LEWES DE
19958-1462
US

IV. Provider business mailing address

PO BOX 459
LEWES DE
19958-0459
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3580
  • Fax:
Mailing address:
  • Phone: 302-645-9492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC10004650
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: