Provider Demographics
NPI:1437104866
Name:DOVER PODIATRY GROUP, P.A.
Entity Type:Organization
Organization Name:DOVER PODIATRY GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HYNES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:302-734-7474
Mailing Address - Street 1:1418 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4948
Mailing Address - Country:US
Mailing Address - Phone:302-734-7474
Mailing Address - Fax:302-674-4170
Practice Address - Street 1:1418 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4948
Practice Address - Country:US
Practice Address - Phone:302-734-7474
Practice Address - Fax:302-674-4170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000062213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0449063000OtherAMERIHEALTH
DE0000148450Medicaid
DE0000148450Medicaid
DET26904Medicare UPIN
DE619726Medicare ID - Type Unspecified