Healthcare Provider Details

I. General information

NPI: 1588528020
Provider Name (Legal Business Name): DHRUVIL ALPESHKUMAR MODI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 MARROWS RD
NEWARK DE
19713-3701
US

IV. Provider business mailing address

PO BOX 151
NEW CASTLE DE
19720-0151
US

V. Phone/Fax

Practice location:
  • Phone: 302-455-0900
  • Fax:
Mailing address:
  • Phone: 302-652-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012424
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: