Healthcare Provider Details

I. General information

NPI: 1457585861
Provider Name (Legal Business Name): HEART GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD SUITE 2123
NEWARK DE
19713-2072
US

IV. Provider business mailing address

4735 OGLETOWN STANTON RD SUITE 2123
NEWARK DE
19713-2072
US

V. Phone/Fax

Practice location:
  • Phone: 302-225-3888
  • Fax: 302-731-7695
Mailing address:
  • Phone: 302-225-3888
  • Fax: 302-731-7695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC10001668
License Number StateDE

VIII. Authorized Official

Name: JOSEPH T WEST
Title or Position: CEO
Credential: M.D.
Phone: 302-225-3888