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General NPI Number Information
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NPI Number | 1053450981
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Entity Type | Organization
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Legal Business Name | ADOLESCENT MEDICINE GENERAL PEDIATRICS & ALLERGY
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 863 BUTTNER PLACE SUITE 103
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City | DOVER
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State | DE
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Zip | 19904-2406
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Country | US
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Telephone | 302-734-3331
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Fax | 302-734-9908
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Provider Business Mailing Address
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Address Line | 863 BUTTNER PLACE SUITE 103
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City | DOVER
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State | DE
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Zip | 19904-2406
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Country | US
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Telephone | 302-734-3331
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Fax | 302-734-9908
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Authorized Official
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Title or Position | OWNER
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Name | DR. FIZUL H BACCHUS
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Credential | DO
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Telephone | 302-734-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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