Healthcare Provider Details

I. General information

NPI: 1720114416
Provider Name (Legal Business Name): SUSAN KATHERINE PASSARELLA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN-STANTON ROAD
NEWARK DE
19701-6001
US

IV. Provider business mailing address

PO BOX 6001 ACADEMIC AFFAIRS SUITE 2100 CHRISTIANA HOSPITAL
NEWARK DE
19718-0001
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-6565
  • Fax:
Mailing address:
  • Phone: 302-733-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC70003273
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: