Healthcare Provider Details

I. General information

NPI: 1174771133
Provider Name (Legal Business Name): PETER R. COGGINS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 KENNETT PIKE
WILMINGTON DE
19807-1137
US

IV. Provider business mailing address

5811 KENNETT PIKE
WILMINGTON DE
19807-1137
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-1115
  • Fax:
Mailing address:
  • Phone: 302-655-1115
  • Fax: 302-655-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER R COGGINS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 302-655-1115