Healthcare Provider Details

I. General information

NPI: 1598790099
Provider Name (Legal Business Name): PETER M WITHERELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 SILVERSIDE ROAD SUITE 103 RODNEY BUILDING
WILMINGTON DE
19810
US

IV. Provider business mailing address

PO BOX 3012
WILMINGTON DE
19804
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-7001
  • Fax: 302-478-7002
Mailing address:
  • Phone: 302-224-5678
  • Fax: 302-224-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberC1-0004878
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: