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General NPI Number Information
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NPI Number | 1689607665
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Entity Type | Organization
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Legal Business Name | HENLOPEN CARDIOLOGY PA
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 123 PENNSYLVANIA AVE
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City | SEAFORD
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State | DE
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Zip | 19973-3829
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Country | US
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Telephone | 302-628-2687
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Fax |
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Provider Business Mailing Address
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Address Line | 18958 COASTAL HWY
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-9791
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Country | US
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Telephone | 302-645-7672
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NASI BOLOURCHI
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Credential |
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Telephone | 302-645-7672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | C10001853
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License Number State | DE
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