Provider Demographics
NPI:1083357420
Name:DEL RE, AUDREY LINA (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LINA
Last Name:DEL RE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WALNUT ST FL 4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5214
Mailing Address - Country:US
Mailing Address - Phone:215-955-9425
Mailing Address - Fax:215-503-4347
Practice Address - Street 1:901 WALNUT ST FL 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5214
Practice Address - Country:US
Practice Address - Phone:942-521-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program