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General NPI Number Information
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NPI Number | 1932822483
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Entity Type | Organization
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Legal Business Name | SOUTHERN DELAWARE VASCULAR INSTITUTE, LLC
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 1537 SAVANNAH RD STE D
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City | LEWES
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State | DE
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Zip | 19958-1611
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Country | US
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Telephone | 302-779-8440
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Fax | 302-779-8383
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Provider Business Mailing Address
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Address Line | 3001 PALM HARBOR BLVD STE A
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City | PALM HARBOR
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State | FL
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Zip | 34683-1930
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Country | US
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Telephone | 727-474-0090
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Fax | 727-474-0055
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Authorized Official
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Title or Position | CEO
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Name | JOHN HADDEN
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Credential |
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Telephone | 302-200-8957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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