Provider Demographics
NPI:1285793810
Name:INTERNAL MEDICINE ASSOCIATES OF DELAWARE COUNTY PC
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF DELAWARE COUNTY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:CIKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-626-0111
Mailing Address - Street 1:3001 GARRETT RD STE C
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2201
Mailing Address - Country:US
Mailing Address - Phone:610-626-0111
Mailing Address - Fax:610-626-4469
Practice Address - Street 1:3001 GARRETT RD STE C
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2201
Practice Address - Country:US
Practice Address - Phone:610-626-0111
Practice Address - Fax:610-626-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA774790Medicare PIN