Healthcare Provider Details

I. General information

NPI: 1225189095
Provider Name (Legal Business Name): CAPE HENLOPEN DERMATOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 KINGS HWY SUITE 110
LEWES DE
19958
US

IV. Provider business mailing address

750 KINGS HWY SUITE 110
LEWES DE
19958
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-6400
  • Fax: 302-644-6409
Mailing address:
  • Phone: 302-644-6400
  • Fax: 302-644-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC10003715
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC50000344
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC10007095
License Number StateDE

VIII. Authorized Official

Name: MITCHELL C STICKLER
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 302-644-6400