Basic Information
| Provider Information | |||||||||
| NPI: | 1073550737 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLOTTS | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4755 OGLETOWN STANTON RD | ||||||||
| Address2: | SUITE LE45 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197182200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027331042 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4755 OGLETOWN STANTON RD | ||||||||
| Address2: | SUITE LE45 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197182200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027331042 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 06/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | AMD-237 | HI | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207P00000X | C7-0005333 | DE | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 56986602 | 05 | HI | MEDICAID | A252930 | 01 | HI | HMSA | OTHER | 9561653 | 01 | HI | UNIV HEALTH ALLIANCE | OTHER |