Provider Demographics
NPI:1619970258
Name:KWAN, DELBERT J (MD)
Entity Type:Individual
Prefix:
First Name:DELBERT
Middle Name:J
Last Name:KWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34431 KING STREET ROW
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4787
Mailing Address - Country:US
Mailing Address - Phone:302-645-2666
Mailing Address - Fax:302-645-6448
Practice Address - Street 1:34431 KING STREET ROW
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4787
Practice Address - Country:US
Practice Address - Phone:302-645-2666
Practice Address - Fax:302-645-6448
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0004875208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000725901Medicaid
000H13U64Medicare ID - Type Unspecified
F88031Medicare UPIN