Provider Demographics
NPI:1891132379
Name:GHASSEM VAKILI, M.D. P.A
Entity Type:Organization
Organization Name:GHASSEM VAKILI, M.D. P.A
Other - Org Name:GHASSEM VAKILI, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GHASSEM
Authorized Official - Middle Name:
Authorized Official - Last Name:VAKILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-738-3540
Mailing Address - Street 1:314 E MAIN ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7128
Mailing Address - Country:US
Mailing Address - Phone:302-738-0555
Mailing Address - Fax:302-738-0810
Practice Address - Street 1:314 E MAIN ST
Practice Address - Street 2:SUITE 406
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7128
Practice Address - Country:US
Practice Address - Phone:302-738-0555
Practice Address - Fax:302-738-0810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10000915207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE47159OtherMEDICARE