Healthcare Provider Details

I. General information

NPI: 1710017017
Provider Name (Legal Business Name): REPRODUCTIVE ASSOCIATES OF DELAWARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD SUITE 3217
NEWARK DE
19713-2072
US

IV. Provider business mailing address

4735 OGLETOWN STANTON RD SUITE 3217
NEWARK DE
19713-2072
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4242
  • Fax: 302-623-4241
Mailing address:
  • Phone: 302-623-4242
  • Fax: 302-623-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number StateDE

VIII. Authorized Official

Name: MARC PORTMANN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 302-623-4230