Basic Information
| Provider Information | |||||||||
| NPI: | 1568580769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CREVAR | ||||||||
| FirstName: | EMBER | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4755 OGLETOWN STANTON RD. | ||||||||
| Address2: | CHRISTIANA HOSPITAL, DEPT OF PEDIATRICS | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19718 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4755 OGLETOWN STANTON RD. | ||||||||
| Address2: | CHRISTIANA CARE HOSPITAL - DEPT. OF PEDIATRICS | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027336500 | ||||||||
| FaxNumber: | 3027332711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 11/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MT189316 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | C1-0009151 | DE | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.