Healthcare Provider Details

I. General information

NPI: 1255385589
Provider Name (Legal Business Name): ROGER KERZNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 CHAPMAN ROAD SUITE 150
NEWARK DE
19702
US

IV. Provider business mailing address

252 CHAPMAN RD SITE 150
NEWARK DE
19702-5438
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-1929
  • Fax: 302-366-1075
Mailing address:
  • Phone: 302-623-1925
  • Fax: 302-366-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberCI0007947
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberC10007947
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: