Provider Demographics
NPI:1073653317
Name:DELAWARE PLASTIC & RECON SURGERY
Entity Type:Organization
Organization Name:DELAWARE PLASTIC & RECON SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDOLLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-994-8492
Mailing Address - Street 1:ONE CENTURIAN DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2127
Mailing Address - Country:US
Mailing Address - Phone:302-994-8492
Mailing Address - Fax:302-994-1155
Practice Address - Street 1:ONE CENTURIAN DR
Practice Address - Street 2:SUITE 301
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2127
Practice Address - Country:US
Practice Address - Phone:302-994-8492
Practice Address - Fax:302-994-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1990025547208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000171202Medicaid
DE769038Medicare PIN