Healthcare Provider Details

I. General information

NPI: 1366716060
Provider Name (Legal Business Name): VASCULAR SPECIALISTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTURIAN DR SUITE 307
NEWARK DE
19713-2137
US

IV. Provider business mailing address

1 CENTURIAN DR SUITE 307
NEWARK DE
19713-2137
US

V. Phone/Fax

Practice location:
  • Phone: 302-543-8100
  • Fax: 302-543-8905
Mailing address:
  • Phone: 302-543-8100
  • Fax: 302-543-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RHONDA DISABATINO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 302-543-8100