Healthcare Provider Details

I. General information

NPI: 1104821198
Provider Name (Legal Business Name): MARC KATTELMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 5 BOX 79
SELBYVILLE DE
19975-9706
US

IV. Provider business mailing address

40 SYCAMORE ST
OCEAN VIEW DE
19970-3217
US

V. Phone/Fax

Practice location:
  • Phone: 302-436-9600
  • Fax: 302-436-6260
Mailing address:
  • Phone: 302-537-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberC2-0006894
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: