Healthcare Provider Details

I. General information

NPI: 1356547277
Provider Name (Legal Business Name): ADELE PATRICIA ASHLEY-AXON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 PENTLAND DR
WILMINGTON DE
19807-1046
US

IV. Provider business mailing address

309 PENTLAND DR
WILMINGTON DE
19807-1046
US

V. Phone/Fax

Practice location:
  • Phone: 302-984-0911
  • Fax: 302-984-0540
Mailing address:
  • Phone: 302-984-0911
  • Fax: 302-984-0540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberC1-0002544
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: