Healthcare Provider Details

I. General information

NPI: 1104942622
Provider Name (Legal Business Name): KIDDOCS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 NEW LINDEN HILL RD BROWNSTONE PLAZA, SUITE 204
WILMINGTON DE
19808-2953
US

IV. Provider business mailing address

4600 NEW LINDEN HILL RD BROWNSTONE PLAZA, SUITE 204
WILMINGTON DE
19808-2953
US

V. Phone/Fax

Practice location:
  • Phone: 302-892-3300
  • Fax: 302-892-9824
Mailing address:
  • Phone: 302-892-3300
  • Fax: 302-892-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0003971
License Number StateDE

VIII. Authorized Official

Name: DR. EPHIGENIA K GIANNOUKOS
Title or Position: OWNER
Credential: M.D.
Phone: 302-892-3300