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General NPI Number Information
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NPI Number | 1164561833
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Entity Type | Organization
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Legal Business Name | DELMARVA BARIATRIC CENTER, P.A.
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 1324 BELMONT AVE SUITE 105
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City | SALISBURY
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State | MD
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Zip | 21804-4543
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Country | US
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Telephone | 410-341-6180
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Fax | 410-341-6190
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Provider Business Mailing Address
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Address Line | 1324 BELMONT AVE SUITE 105
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City | SALISBURY
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State | MD
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Zip | 21804-4543
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Country | US
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Telephone | 410-341-6180
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Fax | 410-341-6190
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL D SOFRONSKI
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Credential | MD
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Telephone | 410-341-6180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0052198
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License Number State | MD
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