Healthcare Provider Details

I. General information

NPI: 1669802856
Provider Name (Legal Business Name): ORTHO-SURG, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 PENNSYLVANIA AVE SUITE 115
WILMINGTON DE
19806-1401
US

IV. Provider business mailing address

2401 PENNSYLVANIA AVE SUITE 115
WILMINGTON DE
19806-1401
US

V. Phone/Fax

Practice location:
  • Phone: 302-658-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA BRODHEAD CLEMMER
Title or Position: SECRETARY OF CORPORATION
Credential: MD
Phone: 302-658-4800