Healthcare Provider Details

I. General information

NPI: 1609876630
Provider Name (Legal Business Name): GASTROENTEROLOGY SPECIALISTS OF DELAWARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GLASGOW AVENUE SUITE 106
NEWARK DE
19702-5704
US

IV. Provider business mailing address

2600 GLASGOW AVENUE SUITE 106
NEWARK DE
19702-5704
US

V. Phone/Fax

Practice location:
  • Phone: 302-832-3755
  • Fax: 302-834-4863
Mailing address:
  • Phone: 302-832-3755
  • Fax: 302-834-4863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1992101864
License Number StateDE

VIII. Authorized Official

Name: DR. GEORGE BENES
Title or Position: OWNER/PARTNER
Credential: MD
Phone: 302-832-3755