NPIMap

Organization Active NPI

Adolescent Medicine General Pediatrics & Allergy

  • Pediatrics Physician
  • Dover, DE
National Provider Identifier
1053450981
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ADOLESCENT MEDICINE GENERAL PEDIATRICS & ALLERGY
Practice address
863 Buttner Place
Suite 103
Dover, DE 19904-2406
Phone
(302) 734-3331
Fax
(302) 734-9908
NPI assigned
Feb 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Fizul H Bacchus, DO
Title
Owner
Phone
(302) 734-3331

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

863 Buttner Place
Suite 103
Dover, DE 19904-2406

Mailing address

863 Buttner Place
Suite 103
Dover, DE 19904-2406
Phone (302) 734-3331

Other identifiers 1

IdentifierTypeStateIssuer
0001036904MedicaidDE

National Provider Directory

National Provider Directory

Locations

863 Buttner Pl
#103
Dover, DE 19904
Phone (302) 734-3331

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053450981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "863 BUTTNER PLACE",
            "address_2": "SUITE 103",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199042406",
            "telephone_number": "302-734-3331",
            "fax_number": "302-734-9908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "863 BUTTNER PLACE",
            "address_2": "SUITE 103",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199042406",
            "telephone_number": "302-734-3331",
            "fax_number": "302-734-9908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADOLESCENT MEDICINE GENERAL PEDIATRICS & ALLERGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BACCHUS",
        "authorized_official_first_name": "FIZUL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "302-734-3331",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001036904",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.