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General NPI Number Information
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NPI Number | 1497097240
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Entity Type | Organization
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Legal Business Name | SAFE HARBOR GYNECOLOGY
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 110 ANGLERS RD SUITE 103
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City | LEWES
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State | DE
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Zip | 19958-1105
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Country | US
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Telephone | 302-644-9641
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Fax | 302-644-9646
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Provider Business Mailing Address
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Address Line | PO BOX 495
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City | LEWES
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State | DE
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Zip | 19958-0495
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Country | US
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Telephone | 302-644-9641
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Fax | 410-548-3747
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Authorized Official
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Title or Position | OWNER
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Name | NANCY MONDERO
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Credential | DO
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Telephone | 302-644-9641
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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 | C20005792
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License Number State | DE
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