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General NPI Number Information
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NPI Number | 1255746590
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Entity Type | Organization
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Legal Business Name | DIAMOND STATE SURGICAL ASSOCIATES,LLC
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 124 SLEEPY HOLLOW DR SUITE 201
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City | MIDDLETOWN
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State | DE
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Zip | 19709-5838
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Country | US
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Telephone | 302-449-9660
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Fax | 302-449-9661
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Provider Business Mailing Address
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Address Line | 124 SLEEPY HOLLOW DR SUITE201
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City | MIDDLETOWN
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State | DE
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Zip | 19709-5838
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Country | US
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Telephone | 302-449-9660
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Fax | 302-449-9661
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Authorized Official
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Title or Position | PHYSICIAN/ OWNER
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Name | DR. KEVIN T.C. GEFFE
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Credential | D.O.
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Telephone | 207-450-6432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | C20010031
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License Number State | DE
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