Healthcare Provider Details

I. General information

NPI: 1881615011
Provider Name (Legal Business Name): DELAWARE DERMATOLOGICAL MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ALDERS LN
WILMINGTON DE
19807-3050
US

IV. Provider business mailing address

14 ALDERS LN
WILMINGTON DE
19807-3050
US

V. Phone/Fax

Practice location:
  • Phone: 302-888-1577
  • Fax:
Mailing address:
  • Phone: 302-888-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: BEN BANSAL
Title or Position: BUS. MGR
Credential:
Phone: 302-888-1577