Provider Demographics
NPI:1225189095
Name:CAPE HENLOPEN DERMATOLOGY, P.A.
Entity Type:Organization
Organization Name:CAPE HENLOPEN DERMATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:STICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-644-6400
Mailing Address - Street 1:750 KINGS HWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958
Mailing Address - Country:US
Mailing Address - Phone:302-644-6400
Mailing Address - Fax:302-644-6409
Practice Address - Street 1:750 KINGS HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-644-6400
Practice Address - Fax:302-644-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003715207N00000X
DEC10007095207N00000X
DEC50000344207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000431701Medicaid
E87878Medicare UPIN
DE0000431701Medicaid