Provider Demographics
NPI:1407805203
Name:NEPHROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-225-0451
Mailing Address - Street 1:4923 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2081
Mailing Address - Country:US
Mailing Address - Phone:032-225-0451
Mailing Address - Fax:302-225-0472
Practice Address - Street 1:4923 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2081
Practice Address - Country:US
Practice Address - Phone:032-225-0451
Practice Address - Fax:302-225-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000078002Medicaid
NJ8818401Medicaid
MD788161400Medicaid
MD788161400Medicaid
DE054974Medicare PIN