1578566907 NPI number — MILLSBORO FAMILY PRACTICE, P.A.

Table of content: (NPI 1578566907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578566907 NPI number — MILLSBORO FAMILY PRACTICE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLSBORO FAMILY PRACTICE, 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:
1578566907
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:
201 LAUREL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLSBORO
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19966-1732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-934-7344
Provider Business Mailing Address Fax Number:
302-934-7345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 LAUREL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLSBORO
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19966-1732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-934-7344
Provider Business Practice Location Address Fax Number:
302-934-7345
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
302-934-7344

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C20005747 , 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)

  • Identifier: 87726 . This is a "UNITED INS. CO." identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 54540001 . This is a "DELMARVA HEALTH INS. CO." identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 876396 . This is a "AETNA INS. CO." identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 890562 . This is a "MAMSI INS. CO." identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 15039 . This is a "MIDATLANTIC INS. CO." identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 187037 . This is a "COVENTRY INS. CO." identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2208964001 . This is a "AMERIHEALTH INS. CO." identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 6697853 . This is a "CIGNA INS. CO." identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 23227 . This is a "JOHNS HOPKINS INS. CO." identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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