1033292016 NPI number — AFFORDABLE HEALTH CARE OF DELAWARE

Table of content: (NPI 1033292016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033292016 NPI number — AFFORDABLE HEALTH CARE OF DELAWARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFORDABLE HEALTH CARE OF DELAWARE
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:
1033292016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 N DUPONT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19977-1511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-653-0903
Provider Business Mailing Address Fax Number:
302-653-1708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 N DUPONT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19977-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-653-0903
Provider Business Practice Location Address Fax Number:
302-653-1708
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANCINO
Authorized Official First Name:
JOSEFINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
302-653-0903

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G0005169 , 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: 250067159 . This is a "ALLIANCE/OPT CHOICE/MAMSI" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: DB3857 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1000024006 . This is a "DELAWARE PHYSICANS CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1000024006 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7048597 . This is a "AETNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2284181000 . This is a "AMERIHEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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