Healthcare Provider Details

I. General information

NPI: 1558440701
Provider Name (Legal Business Name): DELAWARE CLINICAL & LABORATORY PHYSICIANS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD SUITE 4200
NEWARK DE
19713-2055
US

IV. Provider business mailing address

PO BOX 12210
WILMINGTON DE
19850-2210
US

V. Phone/Fax

Practice location:
  • Phone: 302-454-9830
  • Fax: 302-454-1445
Mailing address:
  • Phone: 302-454-9830
  • Fax: 302-454-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY WITKIN
Title or Position: PRESIDENT
Credential: MD
Phone: 302-454-9830