Healthcare Provider Details

I. General information

NPI: 1851307680
Provider Name (Legal Business Name): GAURAV JAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 STANTON CHRISTIANA RD SUITE 203
NEWARK DE
19713
US

IV. Provider business mailing address

537 STANTON CHRISTIANA RD SUITE 203
NEWARK DE
19713
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 NumberC10006985
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: