Provider Demographics
NPI:1881731321
Name:DOVER SURGICENTER, LLC
Entity type:Organization
Organization Name:DOVER SURGICENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PICCIONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-270-2798
Mailing Address - Street 1:100 SCULL TER
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3577
Mailing Address - Country:US
Mailing Address - Phone:302-270-2798
Mailing Address - Fax:
Practice Address - Street 1:100 SCULL TER
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3577
Practice Address - Country:US
Practice Address - Phone:302-270-2798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE165A87OtherBCBS OF DELAWARE
DE165A87OtherBCBS OF DELAWARE