Provider Demographics
NPI:1679614390
Name:UNIVERSITY OF DELAWARE
Entity Type:Organization
Organization Name:UNIVERSITY OF DELAWARE
Other - Org Name:UNIVERSITY OF DE PT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:AIRELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:302-831-2705
Mailing Address - Street 1:540 S COLLEGE AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-1302
Mailing Address - Country:US
Mailing Address - Phone:302-831-8893
Mailing Address - Fax:302-831-4468
Practice Address - Street 1:540 S COLLEGE AVE STE 160
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-1302
Practice Address - Country:US
Practice Address - Phone:302-831-8893
Practice Address - Fax:302-831-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
DEJ1-0000851261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000035397Medicaid
DE086524Medicare Oscar/Certification