Healthcare Provider Details
I. General information
NPI: 1730355678
Provider Name (Legal Business Name): SUSSEX PULMONARY AND ENDOCRINE CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
18947 JOHN J WILLIAMS HWY UNIT 305 BEEBE HEALTH CAMPUS, MEDICAL ARTS CENTER
REHOBOTH BEACH DE
19971-4477
US
IV. Provider business mailing address
21505 WILLOW LN
LEWES DE
19958-6034
US
V. Phone/Fax
- Phone: 302-644-7201
- Fax: 302-644-7218
- Phone: 302-947-4507
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RC0200X |
| Taxonomy | Critical Care Medicine (Internal Medicine) Physician |
| License Number | C10006856 |
| License Number State | DE |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RE0101X |
| Taxonomy | Endocrinology, Diabetes & Metabolism Physician |
| License Number | C10006874 |
| License Number State | DE |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RS0012X |
| Taxonomy | Sleep Medicine (Internal Medicine) Physician |
| License Number | C10006856 |
| License Number State | DE |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RP1001X |
| Taxonomy | Pulmonary Disease Physician |
| License Number | C10006856 |
| License Number State | DE |
VIII. Authorized Official
Name:
REETU
SINGH
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 302-249-9970