Healthcare Provider Details

I. General information

NPI: 1245217652
Provider Name (Legal Business Name): SHIRLEY P KLEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST WILMINGTON HOSPITAL, DEPT OF PEDIATRICS
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

PO BOX 30170
WILMINGTON DE
19805-7170
US

V. Phone/Fax

Practice location:
  • Phone: 302-428-4412
  • Fax: 302-428-4523
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10002404
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: