Healthcare Provider Details

I. General information

NPI: 1457327298
Provider Name (Legal Business Name): JOSEPH W. DEPENBUSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N CLAYTON ST
WILMINGTON DE
19805
US

IV. Provider business mailing address

701 N CLAYTON ST STE 301 MSB
WILMINGTON DE
19805-3165
US

V. Phone/Fax

Practice location:
  • Phone: 302-575-8103
  • Fax: 302-575-8144
Mailing address:
  • Phone: 302-575-8103
  • Fax: 302-575-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberC1-0003887
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: