Healthcare Provider Details

I. General information

NPI: 1750577037
Provider Name (Legal Business Name): DELAWARE VALLEY ENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 PENNSYLVANIA AVE SUITE 1A
WILMINGTON DE
19806-4338
US

IV. Provider business mailing address

PO BOX 9557
WILMINGTON DE
19809-0557
US

V. Phone/Fax

Practice location:
  • Phone: 302-427-2444
  • Fax:
Mailing address:
  • Phone: 302-427-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC10008417
License Number StateDE

VIII. Authorized Official

Name: DR. JOAN FRANCISCA COKER
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 630-291-2013