Healthcare Provider Details

I. General information

NPI: 1255435343
Provider Name (Legal Business Name): UROLOGIC SURGICAL ASSOCIATES OF DELAWARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 302-517-8958
  • Fax: 302-571-1320
Mailing address:
  • Phone: 302-517-8958
  • Fax: 302-571-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2003100929
License Number StateDE

VIII. Authorized Official

Name: FRANCIS JACKSON SCHANNE
Title or Position: PRESIDENT GROUP ADMINISTRATOR
Credential: MD
Phone: 302-571-8958