Healthcare Provider Details

I. General information

NPI: 1588847842
Provider Name (Legal Business Name): ATLANTIC WOMENS MEDICAL SRV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 BAYNARD BLVD
WILMINGTON DE
19802-2967
US

IV. Provider business mailing address

2809 BAYNARD BLVD
WILMINGTON DE
19802-2967
US

V. Phone/Fax

Practice location:
  • Phone: 302-764-1900
  • Fax: 302-764-4905
Mailing address:
  • Phone: 302-764-1900
  • Fax: 302-764-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1993102135
License Number StateDE

VIII. Authorized Official

Name: MR. LEROY T BRINKLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 302-764-1900