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General NPI Number Information
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NPI Number | 1811128242
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Entity Type | Organization
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Legal Business Name | DELAWARE PEDORTHICS
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Dates
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Enumeration Date | 08/03/2009
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Last Update Date | 08/03/2009
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Provider Practice Location Address
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Address Line | 5321 BRANDYWINE PKWY
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City | WILMINGTON
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State | DE
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Zip | 19803-1471
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Country | US
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Telephone | 302-230-3065
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Fax | 302-230-3045
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Provider Business Mailing Address
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Address Line | 5321 BRANDYWINE PKWY
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City | WILMINGTON
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State | DE
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Zip | 19803-1471
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Country | US
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Telephone | 302-230-3065
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Fax | 302-230-3045
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Authorized Official
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Title or Position | PEDORTHIST
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Name | VON MAURICE HOMER
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Credential | BOCPD
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Telephone | 302-230-3065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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