Eden Hill Surgical Group
Organization Active NPI Specialist · Dover, DE
NPI 1487628673 · NPPES record last updated Dec 13, 2013
Key facts
- NPI
- 1487628673
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- License
- C1-0003052 (DE)
- Legal business name
- EDEN HILL SURGICAL GROUP
- Practice address
- 200 Banning St
Suite 310
Dover, DE 19904-3485 - Phone
- (302) 735-8850
- Fax
- (302) 735-8851
- NPI assigned
- Feb 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Brandt J Feuerstein, MD
- Title
- President
- Phone
- (302) 735-8850
Practitioners 1
-
Paul A Fedalen, MD
National Provider Directory
Locations
737 S Queen St
Dover, DE 19904
Phone (302) 644-9000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | C1-0003052 | DE | Yes |
Addresses
Primary practice location
200 Banning St
Suite 310
Dover, DE 19904-3485
Mailing address
200 Banning St
Suite 310
Dover, DE 19904-3485
Phone (302) 735-8850
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000891702 | Medicaid | DE |
Other names
- Glenn & Domenick, MD, PA
Other providers in Dover, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.