Healthcare Provider Details

I. General information

NPI: 1275801631
Provider Name (Legal Business Name): MRI CONSULTANTS LEWES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTURIAN DR STE 107
NEWARK DE
19713-2154
US

IV. Provider business mailing address

17252 N VILLAGE MAIN BLVD STE 9 FIVE POINTS SHOPPING CENTER
LEWES DE
19958-6292
US

V. Phone/Fax

Practice location:
  • Phone: 302-295-3367
  • Fax: 302-999-9897
Mailing address:
  • Phone: 302-566-8600
  • Fax: 888-677-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberC1-0003457
License Number StateDE

VIII. Authorized Official

Name: DR. PHILIP W CHAO
Title or Position: DIRECTOR
Credential: M.D.
Phone: 302-566-6600