Healthcare Provider Details

I. General information

NPI: 1295932861
Provider Name (Legal Business Name): DELAWARE ELECTROPHYSIOLOGY AND CARDIOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GLASGOW AVE SUITE 104
NEWARK DE
19702-4773
US

IV. Provider business mailing address

PO BOX 7541
WILMINGTON DE
19803-0541
US

V. Phone/Fax

Practice location:
  • Phone: 302-762-3585
  • Fax: 302-478-2356
Mailing address:
  • Phone: 302-762-3585
  • Fax: 302-478-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberC10004298
License Number StateDE

VIII. Authorized Official

Name: DR. JOSEPH C PENNINGTON III
Title or Position: PRESENDENT
Credential: MD
Phone: 302-762-3585