Healthcare Provider Details

I. General information

NPI: 1841478757
Provider Name (Legal Business Name): WILLIAM B. FUNK, M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 09/04/2008
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:
Mailing address:
  • Phone: 302-731-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-00001699
License Number StateDE

VIII. Authorized Official

Name: WILLIAM B FUNK
Title or Position: OWNER
Credential: M.D.
Phone: 302-731-0900