Healthcare Provider Details

I. General information

NPI: 1538297569
Provider Name (Legal Business Name): DOROTHY J. WAVREK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD CHRISTINA HOSPITAL
NEWARK DE
19718-2200
US

IV. Provider business mailing address

200 HYGEIA DRIVE SUITE 2300 - PHYSICIAN CONTRACTING
NEWARK DE
19713
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-6500
  • Fax: 302-733-2711
Mailing address:
  • Phone: 610-388-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD431930
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberCI-0011002
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: