Healthcare Provider Details

I. General information

NPI: 1982408423
Provider Name (Legal Business Name): NEPHROLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N CLAYTON ST STE 401
WILMINGTON DE
19805-3165
US

IV. Provider business mailing address

701 N CLAYTON ST STE 401
WILMINGTON DE
19805-3165
US

V. Phone/Fax

Practice location:
  • Phone: 302-421-9411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA LARUE
Title or Position: BILLING MANAGER
Credential:
Phone: 302-225-0462