Healthcare Provider Details

I. General information

NPI: 1285165092
Provider Name (Legal Business Name): JAMES MICHAEL JARVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD STE 5A43
NEWARK DE
19718-2200
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD STE 5A43
NEWARK DE
19718-2200
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-0118
  • Fax: 302-733-5640
Mailing address:
  • Phone: 302-623-0118
  • Fax: 302-733-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD93558
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC1-0025035
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101285006
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: