Provider Demographics
NPI:1144218744
Name:KURZ, FREDERICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:KURZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CAMP DAVID RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3260
Mailing Address - Country:US
Mailing Address - Phone:302-661-2328
Mailing Address - Fax:302-661-2329
Practice Address - Street 1:1601 DELAWARE AVE
Practice Address - Street 2:SUITE 32 B
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3303
Practice Address - Country:US
Practice Address - Phone:302-661-2328
Practice Address - Fax:302-661-2329
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000236103G00000X
NJ35SI00183900103G00000X
PAPS003678L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000744019Medicaid
DEKU189670Medicare ID - Type Unspecified