Healthcare Provider Details

I. General information

NPI: 1982960589
Provider Name (Legal Business Name): RAJI MATHEW CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4051 OGLETOWN-STANTON RD
NEWARK DE
19713-1338
US

IV. Provider business mailing address

1601 MILLTOWN RD STE 2
WILMINGTON DE
19808-4047
US

V. Phone/Fax

Practice location:
  • Phone: 302-943-0426
  • Fax: 877-383-8544
Mailing address:
  • Phone: 302-352-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000658
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: