Healthcare Provider Details

I. General information

NPI: 1770692782
Provider Name (Legal Business Name): WESLEY W EMMONS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 STANTON CHRISTIANA RD SUITE 201
NEWARK DE
19713-2146
US

IV. Provider business mailing address

537 STANTON CHRISTIANA RD SUITE 201
NEWARK DE
19713-2146
US

V. Phone/Fax

Practice location:
  • Phone: 302-994-9692
  • Fax: 302-994-9803
Mailing address:
  • Phone: 302-994-9692
  • Fax: 302-994-9803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberC10002931
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD0060900
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: