Healthcare Provider Details

I. General information

NPI: 1740201995
Provider Name (Legal Business Name): PANZER DERMATOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 STANTON CHRISTIANA RD SUITE 107
NEWARK DE
19713-2146
US

IV. Provider business mailing address

537 STANTON CHRISTIANA RD SUITE 107
NEWARK DE
19713-2146
US

V. Phone/Fax

Practice location:
  • Phone: 302-633-7550
  • Fax: 302-225-3774
Mailing address:
  • Phone: 302-633-7550
  • Fax: 302-225-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1989022601
License Number StateDE

VIII. Authorized Official

Name: MS. MARY PAT KWOKA
Title or Position: PRACTICE ADMINISTRATOR
Credential: MSMHC
Phone: 302-633-7550