Healthcare Provider Details

I. General information

NPI: 1942472485
Provider Name (Legal Business Name): DELAWARE NEUROSURGICAL GRP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 CHRISTIANA RD
NEWARK DE
19713-4236
US

IV. Provider business mailing address

774 CHRISTIANA RD
NEWARK DE
19713-4236
US

V. Phone/Fax

Practice location:
  • Phone: 302-366-7671
  • Fax:
Mailing address:
  • Phone: 302-366-7671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW EPPLEY
Title or Position: PRESIDENT
Credential:
Phone: 302-366-7671