Healthcare Provider Details

I. General information

NPI: 1518902451
Provider Name (Legal Business Name): WILMINGTON OTOLARYNGOLOGY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 PENNSYLVANIA AVE SUITE 2A
WILMINGTON DE
19806-1392
US

IV. Provider business mailing address

2300 PENNSYLVANIA AVE SUITE 2A
WILMINGTON DE
19806-1392
US

V. Phone/Fax

Practice location:
  • Phone: 302-658-0404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number1989016985
License Number StateDE

VIII. Authorized Official

Name: WILLIAM L. MEDFORD
Title or Position: PRES
Credential: MD
Phone: 302-658-0404