1285617894 NPI number — DELMARVA INTERNAL & FAMILY MEDICINE, P.A.

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 1285617894 NPI number — DELMARVA INTERNAL & FAMILY MEDICINE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELMARVA INTERNAL & FAMILY MEDICINE, P.A.
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:
1285617894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1346 S DIVISION ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-7021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-749-2599
Provider Business Mailing Address Fax Number:
410-749-4634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1346 S DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804-7021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-749-2599
Provider Business Practice Location Address Fax Number:
410-749-4634
Provider Enumeration Date:
11/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
BAKER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-749-2599

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  D29168 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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