Provider Demographics
NPI:1710017017
Name:REPRODUCTIVE ASSOCIATES OF DELAWARE
Entity type:Organization
Organization Name:REPRODUCTIVE ASSOCIATES OF DELAWARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-623-4230
Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 3217
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:302-623-4242
Mailing Address - Fax:302-623-4241
Practice Address - Street 1:4735 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 3217
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2072
Practice Address - Country:US
Practice Address - Phone:302-623-4242
Practice Address - Fax:302-623-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE=========OtherEIN NUMBER