Healthcare Provider Details

I. General information

NPI: 1912040452
Provider Name (Legal Business Name): MATTHEW FAVINGER M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 01/31/2008
Certification Date: FAVINGER MATTHEW 25255 GRAVEL HILL RD MILLSBORO DE 19966 25255 GRAVEL HILL RD MILLSBORO DE 19966
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25255 GRAVEL HILL RD
MILLSBORO DE
19966-3468
US

IV. Provider business mailing address

25255 GRAVEL HILL RD
MILLSBORO DE
19966-3468
US

V. Phone/Fax

Practice location:
  • Phone: 302-934-1471
  • Fax: 302-934-9687
Mailing address:
  • Phone: 302-934-1471
  • Fax: 302-934-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number03-0000143
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number02-0000122
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: