Healthcare Provider Details

I. General information

NPI: 1457400210
Provider Name (Legal Business Name): MICHAEL L CENTRELLA, JR DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 GILPIN AVE SUITE 100
WILMINGTON DE
19806-3270
US

IV. Provider business mailing address

1021 GILPIN AVE SUITE 100
WILMINGTON DE
19806-3270
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-6584
  • Fax: 302-655-6910
Mailing address:
  • Phone: 302-655-6584
  • Fax: 302-655-6910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL L CENTRELLA JR.
Title or Position: OWNER
Credential: DPM
Phone: 302-655-6584