Healthcare Provider Details

I. General information

NPI: 1053152652
Provider Name (Legal Business Name): DELAWARE HEART AND VASCULAR GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94A OMEGA DR
NEWARK DE
19713-2066
US

IV. Provider business mailing address

94A OMEGA DR
NEWARK DE
19713-2066
US

V. Phone/Fax

Practice location:
  • Phone: 302-550-3484
  • Fax: 302-556-3484
Mailing address:
  • Phone: 302-550-3484
  • Fax: 302-556-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTONY LESLIE INNASIMUTHU
Title or Position: PHYSICIAN
Credential: MD
Phone: 412-867-8396