Healthcare Provider Details

I. General information

NPI: 1316329261
Provider Name (Legal Business Name): PSYCHIATRY DELAWARE COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 FOULK RD STE 104 FOULKSTONE PLAZA
WILMINGTON DE
19803-2748
US

IV. Provider business mailing address

1415 FOULK RD STE 104 FOULKSTONE PLAZA
WILMINGTON DE
19803-2748
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-1450
  • Fax: 302-478-1430
Mailing address:
  • Phone: 302-478-1450
  • Fax: 302-478-1430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberC20007931
License Number StateDE

VIII. Authorized Official

Name: ANDREW W DONOHUE
Title or Position: OWNER
Credential: D.O.
Phone: 302-478-1450