Healthcare Provider Details

I. General information

NPI: 1326292491
Provider Name (Legal Business Name): ELIZABETH HELEN MUTH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2008
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD CHRISTIANA HOSPITAL, DEPT OF PEDIATRICS
NEWARK DE
19718-0001
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD STE 5A43
NEWARK DE
19718-2200
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-4200
  • Fax: 302-733-4252
Mailing address:
  • Phone: 302-623-0188
  • Fax: 302-623-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN/A
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberC1-0009429
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0009429
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0009429
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: