Healthcare Provider Details

I. General information

NPI: 1528025491
Provider Name (Legal Business Name): GALE L BENTZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17005 OLD ORCHARD RD STE 201
LEWES DE
19958-4828
US

IV. Provider business mailing address

17005 OLD ORCHARD RD
LEWES DE
19958-4828
US

V. Phone/Fax

Practice location:
  • Phone: 302-703-4025
  • Fax: 302-703-4027
Mailing address:
  • Phone: 302-703-4025
  • Fax: 302-703-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: