Healthcare Provider Details

I. General information

NPI: 1073550737
Provider Name (Legal Business Name): KYLE A PLOTTS MD, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD SUITE LE45
NEWARK DE
19718-2200
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD SUITE LE45
NEWARK DE
19718-2200
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1042
  • Fax:
Mailing address:
  • Phone: 302-733-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-237
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC7-0005333
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: