Healthcare Provider Details

I. General information

NPI: 1992809628
Provider Name (Legal Business Name): EASTERN SHORES GASTROENTEROLOGY ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 302-645-9325
  • Fax: 302-645-5214
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 Number
License Number State

VIII. Authorized Official

Name: ROBERT C DECKMANN
Title or Position: PHYSICIAN PARTNER
Credential: MD
Phone: 302-645-9325