Provider Demographics
NPI:1659488468
Name:ENDOCRINOLOGY CONSULTANT PA
Entity Type:Organization
Organization Name:ENDOCRINOLOGY CONSULTANT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-855-9099
Mailing Address - Street 1:9 E LOOCKERMAN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-8306
Mailing Address - Country:US
Mailing Address - Phone:302-734-2782
Mailing Address - Fax:302-734-2784
Practice Address - Street 1:9 E LOOCKERMAN ST
Practice Address - Street 2:SUITE A
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-8306
Practice Address - Country:US
Practice Address - Phone:302-734-2782
Practice Address - Fax:302-734-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005520207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG02203Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER