Healthcare Provider Details

I. General information

NPI: 1538573571
Provider Name (Legal Business Name): TYLER M BATES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 BLACK SWAN DR STE 104
LEWES DE
19958-4991
US

IV. Provider business mailing address

1515 SAVANNAH RD STE 200
LEWES DE
19958-1675
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-1315
  • Fax: 833-437-1399
Mailing address:
  • Phone: 302-645-3499
  • Fax: 302-644-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT016123
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0012700
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: