Provider Demographics
NPI:1538859301
Name:COVERDALE, MARKHIYE TAYRON I
Entity type:Individual
Prefix:
First Name:MARKHIYE
Middle Name:TAYRON
Last Name:COVERDALE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 DUMONT RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-1002
Mailing Address - Country:US
Mailing Address - Phone:302-332-7260
Mailing Address - Fax:
Practice Address - Street 1:208 DUMONT RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-1002
Practice Address - Country:US
Practice Address - Phone:302-332-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1627311343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)