Healthcare Provider Details

I. General information

NPI: 1316908866
Provider Name (Legal Business Name): ELVA GRACE DELPORT MKD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELVA GRACE PEARSON MD

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN-STANTON RD SUITE 2210
NEWARK DE
19713
US

IV. Provider business mailing address

4735 OGLETOWN-STANTON RD SUITE 2210
NEWARK DE
19713
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4144
  • Fax: 302-623-4147
Mailing address:
  • Phone: 302-623-4144
  • Fax: 302-623-4147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberC10005721
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: