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General NPI Number Information
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NPI Number | 1194853952
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Entity Type | Individual
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Provider Name | ANTON GRANT DELPORT MD
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Gender | Male
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 4755 OGLETOWN-STANTON ROADROOM 2A00-CHRISTIANA HOSPITAL
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City | NEWARK
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State | DE
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Zip | 19718-0001
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Country | US
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Telephone | 302-733-1041
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Fax |
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Provider Business Mailing Address
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Address Line | 619 ANDOVER RD
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City | WILMINGTON
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State | DE
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Zip | 19803-2202
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Country | US
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Telephone | 302-494-8359
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD442182
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | C1-0009922
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License Number State | DE
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