Healthcare Provider Details

I. General information

NPI: 1043379290
Provider Name (Legal Business Name): DELAWARE VASCULAR ASSOCIATES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD MEDICAL ARTS PAVILION 2 SUITE 1208
NEWARK DE
19713-2072
US

IV. Provider business mailing address

4735 OGLETOWN STANTON RD MEDICAL ARTS PAVILION 2 SUITE 1208
NEWARK DE
19713-2072
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-5700
  • Fax: 302-733-5373
Mailing address:
  • Phone: 302-733-5700
  • Fax: 302-733-5373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number1998205736
License Number StateDE

VIII. Authorized Official

Name: DR. F TODD HARAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 302-733-5700