Healthcare Provider Details

I. General information

NPI: 1396038154
Provider Name (Legal Business Name): KATHLEEN PITTERLE PETRICK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN MARIE PITTERLE DO

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ROCKLAND ROAD
WILMINGTON DE
19803
US

IV. Provider business mailing address

1600 ROCKLAND ROAD
WILMINGTON DE
19803
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-4500
  • Fax: 302-651-4543
Mailing address:
  • Phone: 302-651-4500
  • Fax: 302-651-4543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number262292
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberC2-0012722
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: