Healthcare Provider Details

I. General information

NPI: 1326481177
Provider Name (Legal Business Name): DELAWARE OTOLARYNGOLOGY CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CLAYTON STREET
WILMINGTON DE
19805-3165
US

IV. Provider business mailing address

700 CLAYTON STREET
WILMINGTON DE
19805-3165
US

V. Phone/Fax

Practice location:
  • Phone: 302-332-7600
  • Fax: 302-656-0753
Mailing address:
  • Phone: 302-332-7600
  • Fax: 302-656-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC1-0009167
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BETH R DUNCAN
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 302-332-7600