Healthcare Provider Details

I. General information

NPI: 1710414628
Provider Name (Legal Business Name): ALEXIA K ARHONTAKIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIA K FOLLWEILER PA-C

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD STE 2300
NEWARK DE
19713-2055
US

IV. Provider business mailing address

4701 OGLETOWN STANTON RD STE 2300
NEWARK DE
19713-2055
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-7782
  • Fax: 302-738-5917
Mailing address:
  • Phone: 302-731-7782
  • Fax: 302-738-5917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA059072
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0011598
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: