Healthcare Provider Details

I. General information

NPI: 1588898597
Provider Name (Legal Business Name): JEFFREY M GUARINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FOULK ROAD SUITE 100B
WILMINGTON DE
19803-2764
US

IV. Provider business mailing address

200 HYGEIA DR SUITE 2300
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberC1-0009551
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0009551
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: