Healthcare Provider Details

I. General information

NPI: 1346266863
Provider Name (Legal Business Name): JOHN AUSTIN DEFRATE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S DUPONT HWY
NEW CASTLE DE
19720-4606
US

IV. Provider business mailing address

95 ROSE ANN LN
WEST GROVE PA
19390-8924
US

V. Phone/Fax

Practice location:
  • Phone: 302-328-3330
  • Fax: 302-328-9336
Mailing address:
  • Phone: 302-328-3330
  • Fax: 302-328-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberCL0005148
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD061195L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: