Healthcare Provider Details

I. General information

NPI: 1790831667
Provider Name (Legal Business Name): ENDOCRINE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON ROAD SUITE 208
NEWARK DE
19713-2067
US

IV. Provider business mailing address

4745 OGLETOWN STANTON ROAD SUITE 208
NEWARK DE
19713-2067
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-0606
  • Fax: 302-731-1656
Mailing address:
  • Phone: 302-731-0606
  • Fax: 302-731-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberC10001669
License Number StateDE

VIII. Authorized Official

Name: VALERIE ANNE WEST
Title or Position: PHYSICIAN OWNER
Credential: MD FACE
Phone: 302-731-0606