Healthcare Provider Details

I. General information

NPI: 1851485205
Provider Name (Legal Business Name): SAMUEL JOSEPH DOOCHACK RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA MEDICAL CTR 1601 KRIKWOOD HWY
WILMINGTON DE
19805
US

IV. Provider business mailing address

49 BOYDS VALLEY RD
NEWARK DE
19711
US

V. Phone/Fax

Practice location:
  • Phone: 302-633-5256
  • Fax: 302-633-5378
Mailing address:
  • Phone: 302-737-6707
  • Fax: 302-737-6707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberL1-0012059
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: