Healthcare Provider Details

I. General information

NPI: 1407644826
Provider Name (Legal Business Name): LENA ELIZABETH DIFULVIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2025
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ROCKLAND RD STE 3D16
WILMINGTON DE
19803-3607
US

IV. Provider business mailing address

1508 RIDGE AVE APT 402
PHILADELPHIA PA
19130-2389
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-5874
  • Fax: 302-651-5954
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: