Basic Information
| Provider Information | |||||||||
| NPI: | 1881900561 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DELAWARE PSYCHIATRIC CENTER RESEIDENT PROGRAM | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 N. DUPONT HIGHWAY | ||||||||
| Address2: | DELAWARE PSYCHIATRIC CENTER | ||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022552707 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 N DUPONT HWY | ||||||||
| Address2: | DELAWARE PSYCHIATRIC CENTER RESIDENT PROGRAM | ||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197201160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022552707 | ||||||||
| FaxNumber: | 3022554422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2010 | ||||||||
| LastUpdateDate: | 08/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | TRIMZI | ||||||||
| AuthorizedOfficialFirstName: | IMRAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3022552730 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | C70004576 | DE | Y | Hospitals | Psychiatric Hospital |
No ID Information.