Basic Information
| Provider Information | |||||||||
| NPI: | 1588755961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UN | ||||||||
| FirstName: | DOLORES | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | CORPORATE CREDENTIALING | ||||||||
| Address2: | P.O. BOX 269 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026515938 | ||||||||
| FaxNumber: | 3026516077 | ||||||||
| Practice Location | |||||||||
| Address1: | NEMOURS PEDIATRICS PEOPLES PLAZA | ||||||||
| Address2: | 1400 PEOPLES PLAZA STE. 300 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028367820 | ||||||||
| FaxNumber: | 3028367826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | C10002569 | DE | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1594850 (PA) | 05 | DE | MEDICAID |