Healthcare Provider Details

I. General information

NPI: 1710404223
Provider Name (Legal Business Name): MEGAN KLAPHAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2536
US

IV. Provider business mailing address

4735 OGLETOWN STANTON RD STE 3301
NEWARK DE
19713-7021
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1000
  • Fax:
Mailing address:
  • Phone: 302-623-4370
  • Fax: 302-623-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0011541
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA059211
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: