Organization
ADOLESCENT MEDICINE GENERAL PEDIATRICS & ALLERGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FIZUL H BACCHUS DO (OWNER)
(302) 734-3331
Entity
Organization
Contact information
Practice address
863 BUTTNER PLACE, SUITE 103, DOVER, DE 19904-2406
(302) 734-3331
(302) 734-9908
Mailing address
863 BUTTNER PLACE, SUITE 103, DOVER, DE 19904-2406
(302) 734-3331
(302) 734-9908
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0001036904
—
DE
Enumeration date
02/06/2007
Last updated
08/22/2020
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