Healthcare Provider Details

I. General information

NPI: 1780123810
Provider Name (Legal Business Name): STEPHEN KYDD-HINDELANG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

IV. Provider business mailing address

450 N MILL RD
KENNETT SQUARE PA
19348-2426
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1840
  • Fax:
Mailing address:
  • Phone: 484-883-1571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0001120
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: