Healthcare Provider Details

I. General information

NPI: 1598898934
Provider Name (Legal Business Name): ABDEL-MISIH/BENNETT, MDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD SUITE 4000
NEWARK DE
19713-2055
US

IV. Provider business mailing address

4701 OGLETOWN STANTON RD SUITE 4000
NEWARK DE
19713-2055
US

V. Phone/Fax

Practice location:
  • Phone: 302-658-7533
  • Fax:
Mailing address:
  • Phone: 302-658-7533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateDE

VIII. Authorized Official

Name: DR. RAAFAT Z ABDEL-MISIH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 302-658-7533