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JUSTIN FLEEGLE PA-C
Complete NPI Record 1477029353
Physician Assistant - Surgical in Newark, DE


Quality Rating: 44.82 out of 100 score

NPI Status: Active since October 18, 2018

Contact Information

774 CHRISTIANA ROAD
SUITE 202
NEWARK, DE
ZIP 19713
Phone: (302) 366-7671
Fax: (302) 366-7549

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Credential Text
  6. Provider First Line Business Mailing Address
  7. Provider Second Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Second Line Business Practice Location Address
  16. Provider Business Practice Location Address City Name
  17. Provider Business Practice Location Address State Name
  18. Provider Business Practice Location Address Postal Code
  19. Provider Business Practice Location Address Country Code If outside U S
  20. Provider Business Practice Location Address Telephone Number
  21. Provider Business Practice Location Address Fax Number
  22. Provider Enumeration Date
  23. Last Update Date
  24. Provider Gender Code
  25. Healthcare Provider Taxonomy Code 1
  26. Provider License Number 1
  27. Provider License Number State Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Is Sole Proprietor
  30. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1477029353. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1477029353
The date that a record was last updated or changed.
Entity Type Code: 1
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
The first name of the authorized official.
Provider First Name: JUSTIN
The middle name of the authorized official.
Provider Credential Text: PA-C
The title or position of the authorized official.
Provider First Line Business Mailing Address: 774 CHRISTIANA ROAD
The 10-position telephone number of the authorized official.
Provider Second Line Business Mailing Address: SUITE 202
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: NEWARK
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: DE
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 19713
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 3023667671
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 3023667549
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 774 CHRISTIANA ROAD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE 202
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: NEWARK
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: DE
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 19713
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 3023667671
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 3023667549
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 10/18/2018
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/28/2019
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 363AS0400X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: C5-0001271
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: DE
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Sole Proprietor: Y
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP