Healthcare Provider Details

I. General information

NPI: 1316065022
Provider Name (Legal Business Name): JOHN DAVID CARNEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD
NEWARK DE
19713-2067
US

IV. Provider business mailing address

321 NORMAN DR
NEWARK DE
19702-2394
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1000
  • Fax:
Mailing address:
  • Phone: 302-983-2082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC5-0000384
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: