=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689906109
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOVER OB-GYN ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2010
-----------------------------------------------------
Last Update Date | 05/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 SAULSBURY RD
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19904-3444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-734-9200
-----------------------------------------------------
Fax | 302-730-8615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 SAULSBURY RD
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19904-3444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-734-9200
-----------------------------------------------------
Fax | 302-730-8615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | ALTON A TROTT
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 302-734-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number | C200008667
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------