Healthcare Provider Details

I. General information

NPI: 1265489173
Provider Name (Legal Business Name): DAVID P WIEN, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 GREENBANK RD
WILMINGTON DE
19808-3168
US

IV. Provider business mailing address

708 GREENBANK RD
WILMINGTON DE
19808-3168
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-1866
  • Fax: 302-998-3261
Mailing address:
  • Phone: 302-998-1866
  • Fax: 302-998-3261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberC10005662
License Number StateDE

VIII. Authorized Official

Name: DR. DAVID PETER WIEN
Title or Position: OWNER
Credential: MD
Phone: 302-998-1866