Healthcare Provider Details

I. General information

NPI: 1457350159
Provider Name (Legal Business Name): RAMAZ METREVELI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 LIMESTONE RD SUITE 207
WILMINGTON DE
19808-5408
US

IV. Provider business mailing address

1941 LIMESTONE RD SUITE 207
WILMINGTON DE
19808-5408
US

V. Phone/Fax

Practice location:
  • Phone: 302-994-3128
  • Fax: 302-998-6991
Mailing address:
  • Phone: 302-994-3128
  • Fax: 302-998-6991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC10006581
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD432554
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: