Provider Demographics
NPI:1215120316
Name:FAMILY MEDICAL CENTRE PA
Entity type:Organization
Organization Name:FAMILY MEDICAL CENTRE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:KHOA
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-678-0510
Mailing Address - Street 1:111 WOLF CREEK BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4969
Mailing Address - Country:US
Mailing Address - Phone:302-983-4968
Mailing Address - Fax:302-678-2864
Practice Address - Street 1:111 WOLF CREEK BLVD STE 2
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4969
Practice Address - Country:US
Practice Address - Phone:302-678-0510
Practice Address - Fax:302-678-2864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10008350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty