Healthcare Provider Details

I. General information

NPI: 1154563237
Provider Name (Legal Business Name): JOSEPH J STRAIGHT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD SUITE 225
NEWARK DE
19713-2067
US

IV. Provider business mailing address

4745 OGLETOWN STANTON RD SUITE 225
NEWARK DE
19713-2067
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-2888
  • Fax: 302-731-7049
Mailing address:
  • Phone: 302-731-2888
  • Fax: 302-731-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberC10008348
License Number StateDE

VIII. Authorized Official

Name: DR. JOSEPH JAMES STRAIGHT
Title or Position: DOCTOR
Credential: M.D.
Phone: 302-731-2888