Healthcare Provider Details

I. General information

NPI: 1437185550
Provider Name (Legal Business Name): NANTICOKE GYN ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N FRONT ST SUITE B NANTICOKE GYN ASSOC, PA
SEAFORD DE
19973-2707
US

IV. Provider business mailing address

10 TIDEWATER DR
SEAFORD DE
19973-9768
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-2434
  • Fax: 302-629-2459
Mailing address:
  • Phone: 302-629-2434
  • Fax: 302-629-2459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberC10002432
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberLH0000104
License Number StateDE

VIII. Authorized Official

Name: DR. JAMES PAUL RUPP
Title or Position: OWNER
Credential: M.D.
Phone: 302-629-2434