Healthcare Provider Details

I. General information

NPI: 1528111788
Provider Name (Legal Business Name): MOW FOOT & ANKLE CENTER P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 LAKEVIEW AVE
MILFORD DE
19963
US

IV. Provider business mailing address

PO BOX 165 505 LAKEVIEW AVE
MILFORD DE
19963
US

V. Phone/Fax

Practice location:
  • Phone: 302-424-1760
  • Fax: 302-424-1761
Mailing address:
  • Phone: 302-424-1760
  • Fax: 302-424-1761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE10000109
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE10000109
License Number StateDE

VIII. Authorized Official

Name: DR. EDWIN M MOW
Title or Position: PRESIDENT OF CORP
Credential:
Phone: 302-424-1760