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General NPI Number Information
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NPI Number | 1134348527
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Entity Type | Organization
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Legal Business Name | ELIAS MAMBERG MD PA
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 1301 NORTH HARRISON STREET
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City | WILMINGTON
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State | DE
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Zip | 19806
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Country | US
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Telephone | 302-428-0337
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 N HARRISON ST
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City | WILMINGTON
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State | DE
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Zip | 19806-3128
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Country | US
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Telephone | 302-428-0337
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ELAIS MAMBERG
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Credential |
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Telephone | 302-428-0337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 207V00000X
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License Number State | DE
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