1053513127 NPI number — GEORGETOWN MEDICAL ASSOCIATES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053513127 NPI number — GEORGETOWN MEDICAL ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGETOWN MEDICAL ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053513127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20930 DUPONT BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19947-1725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-856-3737
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20930 DUPONT BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19947-1725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-856-3737
Provider Business Practice Location Address Fax Number:
302-856-7337
Provider Enumeration Date:
06/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HELOU
Authorized Official First Name:
BESHARA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
MEMEBER
Authorized Official Telephone Number:
302-856-3737

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  C1-0005142 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)