Provider Demographics
NPI:1093797078
Name:DOVER PULMONARY, P.A.
Entity Type:Organization
Organization Name:DOVER PULMONARY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-734-0400
Mailing Address - Street 1:31 GOODEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4143
Mailing Address - Country:US
Mailing Address - Phone:302-734-0400
Mailing Address - Fax:302-734-0472
Practice Address - Street 1:31 GOODEN AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-734-0400
Practice Address - Fax:302-734-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000861504Medicaid
DEG00073Medicare ID - Type Unspecified