Healthcare Provider Details

I. General information

NPI: 1598796286
Provider Name (Legal Business Name): WILLIAM B FUNK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 CHURCHMANS RD
NEWARK DE
19702-1918
US

IV. Provider business mailing address

665 CHURCHMANS RD
NEWARK DE
19702-1918
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-0900
  • Fax: 302-731-7100
Mailing address:
  • Phone: 302-731-0900
  • Fax: 302-731-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC10001699
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: