Healthcare Provider Details

I. General information

NPI: 1538489687
Provider Name (Legal Business Name): MARCIN ANDREW JANKOWSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD STE 3301
NEWARK DE
19713-7021
US

IV. Provider business mailing address

4735 OGLETOWN STANTON RD STE 3301
NEWARK DE
19713-7021
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4370
  • Fax: 302-623-4375
Mailing address:
  • Phone: 302-623-4370
  • Fax: 302-623-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberOS014152
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberC2-0013421
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: