Healthcare Provider Details

I. General information

NPI: 1124036017
Provider Name (Legal Business Name): HARRY J ANAGNOSTAKOS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SAVANNAH RD SUITE B
LEWES DE
19958-1499
US

IV. Provider business mailing address

33663 BAYVIEW MEDICAL DR UNIT 2
LEWES DE
19958-1663
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3555
  • Fax: 302-644-3560
Mailing address:
  • Phone: 302-645-9325
  • Fax: 302-645-5214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC20003464
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: