1902817018 NPI number — DR. ANDREW H DEMICHELE MD

Table of content: DR. ANDREW H DEMICHELE MD (NPI 1902817018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902817018 NPI number — DR. ANDREW H DEMICHELE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMICHELE
Provider First Name:
ANDREW
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1902817018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19803-8157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-652-6050
Provider Business Mailing Address Fax Number:
302-652-6053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 SHALLCROSS AVE
Provider Second Line Business Practice Location Address:
SUITE 1 A
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19806-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-652-6050
Provider Business Practice Location Address Fax Number:
302-652-6053
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD058617L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: C10007635 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0005353635 . This is a "AETNA PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000035615 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016931600005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005353635 . This is a "AETNA PIN" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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