Healthcare Provider Details

I. General information

NPI: 1396998738
Provider Name (Legal Business Name): STEPHEN LEONARD GILPIN CNMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HUNTER CT
WILMINGTON DE
19808-1978
US

IV. Provider business mailing address

102 HUNTER CT
WILMINGTON DE
19808-1978
US

V. Phone/Fax

Practice location:
  • Phone: 302-893-9741
  • Fax:
Mailing address:
  • Phone: 302-893-9741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number6313
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: