Provider Demographics
NPI:1285617894
Name:DELMARVA INTERNAL & FAMILY MEDICINE, P.A.
Entity type:Organization
Organization Name:DELMARVA INTERNAL & FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BAKER
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-749-2599
Mailing Address - Street 1:1346 S DIVISION ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-7021
Mailing Address - Country:US
Mailing Address - Phone:410-749-2599
Mailing Address - Fax:410-749-4634
Practice Address - Street 1:1346 S DIVISION ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-7021
Practice Address - Country:US
Practice Address - Phone:410-749-2599
Practice Address - Fax:410-749-4634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD29168305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD73795Medicare UPIN
MD917MJ089Medicare ID - Type Unspecified