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General NPI Number Information
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NPI Number | 1912086018
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Entity Type | Organization
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Legal Business Name | TRAUMA REHABILITATION , P.A.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11B TROLLEY SQ
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City | WILMINGTON
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State | DE
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Zip | 19806-3342
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Country | US
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Telephone | 302-777-7723
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Fax | 302-777-3454
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Provider Business Mailing Address
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Address Line | 11B TROLLEY SQ
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City | WILMINGTON
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State | DE
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Zip | 19806-3342
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Country | US
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Telephone | 302-777-7723
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Fax | 302-777-3454
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Authorized Official
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Title or Position | OFFICER
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Name | DR. PETER BOHDAN BANDERA
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Credential | MD
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Telephone | 302-777-7723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | C1-0003885
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License Number State | DE
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