Healthcare Provider Details

I. General information

NPI: 1841556891
Provider Name (Legal Business Name): RACHEL A OVERDEVEST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL ALLYN MARTIN M.D.

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 SKYLINE DR STE 4
WILMINGTON DE
19808-1772
US

IV. Provider business mailing address

PO BOX 191
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 302-239-7755
  • Fax: 302-234-2735
Mailing address:
  • Phone: 302-651-4200
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0011317
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: