Healthcare Provider Details

I. General information

NPI: 1750810305
Provider Name (Legal Business Name): DELMARVA PAIN & SPINE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTURIAN DR STE 110
NEWARK DE
19713-2154
US

IV. Provider business mailing address

1 CENTURIAN DR STE 110
NEWARK DE
19713-2154
US

V. Phone/Fax

Practice location:
  • Phone: 302-355-0900
  • Fax: 302-355-0901
Mailing address:
  • Phone: 302-355-0900
  • Fax: 302-355-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHACHI PATEL
Title or Position: OWNER
Credential: MD
Phone: 302-355-0090