Provider Demographics
NPI:1134107840
Name:JASANI, ANILKUMAR B (MD)
Entity Type:Individual
Prefix:
First Name:ANILKUMAR
Middle Name:B
Last Name:JASANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANILKUMAR
Other - Middle Name:B
Other - Last Name:JASANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3048
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804
Mailing Address - Country:US
Mailing Address - Phone:302-224-5678
Mailing Address - Fax:302-224-2848
Practice Address - Street 1:4755 OGLETOWN-STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718
Practice Address - Country:US
Practice Address - Phone:302-733-1840
Practice Address - Fax:302-733-1633
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003327207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000061901Medicaid
DE0000061901Medicaid
E41848Medicare UPIN