Provider Demographics
NPI:1912976705
Name:HAUPT, DARLENE L (DO)
Entity type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:L
Last Name:HAUPT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36450 TIDAL RD
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-4596
Mailing Address - Country:US
Mailing Address - Phone:302-291-6045
Mailing Address - Fax:833-449-3867
Practice Address - Street 1:36450 TIDAL RD
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-4596
Practice Address - Country:US
Practice Address - Phone:302-291-6045
Practice Address - Fax:833-449-3867
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009604L207Q00000X
DEC2-0024357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001669905Medicaid
PA001669905Medicaid
PA003654Medicare ID - Type Unspecified