Healthcare Provider Details

I. General information

NPI: 1740292176
Provider Name (Legal Business Name): WILLIAM J SCHICKLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 03/07/2013
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 NumberC10002658
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: