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General NPI Number Information
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NPI Number | 1568922672
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Entity Type | Organization
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Legal Business Name | DELMARVA DERMATOLOGY, LLC
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Dates
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Enumeration Date | 03/24/2019
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Last Update Date | 03/24/2019
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Provider Practice Location Address
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Address Line | 32895 COASTAL HWY # 102A
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City | BETHANY BEACH
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State | DE
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Zip | 19930-3782
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Country | US
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Telephone | 302-402-3015
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Fax | 302-402-5942
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Provider Business Mailing Address
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Address Line | PO BOX 1329
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City | BETHANY BEACH
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State | DE
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Zip | 19930-1329
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Country | US
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Telephone | 302-402-3015
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER Z. COOPER
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Credential | M.D.
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Telephone | 302-402-3015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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