Provider Demographics
NPI:1295214120
Name:PHELPS, DARQUIN LAMAR
Entity Type:Individual
Prefix:
First Name:DARQUIN
Middle Name:LAMAR
Last Name:PHELPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 SEWARD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2845
Mailing Address - Country:US
Mailing Address - Phone:585-402-9143
Mailing Address - Fax:
Practice Address - Street 1:290 SEWARD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2845
Practice Address - Country:US
Practice Address - Phone:585-402-9143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)