Healthcare Provider Details

I. General information

NPI: 1053464560
Provider Name (Legal Business Name): DR. CLYDE A. MAXWELL JR, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E LEA BLVD
WILMINGTON DE
19802-2353
US

IV. Provider business mailing address

303 E LEA BLVD
WILMINGTON DE
19802-2353
US

V. Phone/Fax

Practice location:
  • Phone: 302-765-3373
  • Fax: 302-765-3379
Mailing address:
  • Phone: 302-476-8896
  • Fax: 302-842-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberG1-0001159
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CLYDE A MAXWELL JR.
Title or Position: DENTIST
Credential: DDS
Phone: 302-476-8896