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General NPI Number Information
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NPI Number | 1053612804
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Entity Type | Organization
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Legal Business Name | HENRY U. ISIOCHA LLC
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 1177B S GOVERNORS AVE
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City | DOVER
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State | DE
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Zip | 19904-6903
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Country | US
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Telephone | 302-747-7903
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Fax | 302-747-7906
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Provider Business Mailing Address
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Address Line | 1177B S GOVERNORS AVE
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City | DOVER
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State | DE
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Zip | 19904-6903
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Country | US
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Telephone | 302-747-7903
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Fax | 302-747-7906
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Authorized Official
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Title or Position | PHYSICIAN
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Name | HENRY U ISIOCHA
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Credential | M.D.
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Telephone | 302-747-7903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | C1-0005027
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | C1-0005027
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License Number State | DE
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