Healthcare Provider Details

I. General information

NPI: 1487610416
Provider Name (Legal Business Name): ROBERT E WISNIEWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD SUITE 106
NEWARK DE
19713-2067
US

IV. Provider business mailing address

4735 OGLETOWN STANTON RD SUITE 1109
NEWARK DE
19713-2072
US

V. Phone/Fax

Practice location:
  • Phone: 302-454-9800
  • Fax: 302-454-6446
Mailing address:
  • Phone: 302-454-9800
  • Fax: 302-454-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC10001968
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: