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General NPI Number Information
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NPI Number | 1497839419
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Entity Type | Individual
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Provider Name | IOANNIS KEHAGIAS-ATHANASSOPULOS MD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 222 CARTER DR STE 101
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City | MIDDLETOWN
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State | DE
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Zip | 19709-5854
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Country | US
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Telephone | 302-378-5494
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Fax | 302-378-1760
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Provider Business Mailing Address
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Address Line | 222 CARTER DR STE 101
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City | MIDDLETOWN
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State | DE
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Zip | 19709-5854
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Country | US
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Telephone | 302-378-5494
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Fax | 302-378-1760
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C10006722
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License Number State | DE
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