Basic Information
| Provider Information | |||||||||
| NPI: | 1538297569 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAVREK | ||||||||
| FirstName: | DOROTHY | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HYGEIA DRIVE | ||||||||
| Address2: | SUITE 2300 - PHYSICIAN CONTRACTING | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103889559 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4755 OGLETOWN STANTON RD | ||||||||
| Address2: | CHRISTINA HOSPITAL | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197182200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027336500 | ||||||||
| FaxNumber: | 3027332711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/16/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD431930 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | CI-0011002 | DE | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.