Provider Demographics
NPI:1720291404
Name:DAVIRATANASILPA, SVASTIJAYA (MD)
Entity type:Individual
Prefix:
First Name:SVASTIJAYA
Middle Name:
Last Name:DAVIRATANASILPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2081
Mailing Address - Country:US
Mailing Address - Phone:302-225-0451
Mailing Address - Fax:302-225-0470
Practice Address - Street 1:1198 S GOVERNORS AVE STE B100
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6930
Practice Address - Country:US
Practice Address - Phone:302-424-3694
Practice Address - Fax:302-424-3697
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008993207RN0300X
PAMT184883207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0203190Medicaid
DE1720291404Medicaid
DE155816ZBZRMedicare PIN