Healthcare Provider Details

I. General information

NPI: 1124418249
Provider Name (Legal Business Name): IERARDI VASCULAR CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W 13TH ST SUITE 4
WILMINGTON DE
19806-4054
US

IV. Provider business mailing address

1815 W 13TH ST SUITE 4
WILMINGTON DE
19806-4054
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberC1-0008237
License Number StateDE

VIII. Authorized Official

Name: RALPH IERARDI
Title or Position: PRESIDENT
Credential: MD
Phone: 302-733-5700