Healthcare Provider Details

I. General information

NPI: 1407805203
Provider Name (Legal Business Name): NEPHROLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 OGLETOWN STANTON RD SUITE 200
NEWARK DE
19713-2081
US

IV. Provider business mailing address

4923 OGLETOWN STANTON RD SUITE 200
NEWARK DE
19713-2081
US

V. Phone/Fax

Practice location:
  • Phone: 32-225-0451
  • Fax: 302-225-0472
Mailing address:
  • Phone: 32-225-0451
  • Fax: 302-225-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTIN F GAVIN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 302-225-0451