Individual
DR. COLLEEN R. WITHERELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
NEMOURS PEDIATRICS JESSUP ST., 1602 JESSUP STREET, WILMINGTON, DE 19802-4210
(302) 576-5050
(302) 576-5065
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
C10006211
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001860698
—
PA
05
—
2259901
—
NY
05
—
6883036
—
MD
05
—
8631506
—
NJ
Enumeration date
09/28/2006
Last updated
09/02/2011
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