Healthcare Provider Details

I. General information

NPI: 1487783767
Provider Name (Legal Business Name): DR. CHRISTINE MANLEY HERDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 STANTON CHRISTIANA RD SUITE 203
NEWARK DE
19713-2146
US

IV. Provider business mailing address

537 STANTON CHRISTIANA RD SUITE 203
NEWARK DE
19713-2146
US

V. Phone/Fax

Practice location:
  • Phone: 302-225-2380
  • Fax: 302-225-2388
Mailing address:
  • Phone: 302-225-2380
  • Fax: 302-225-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC10009738
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: