Provider Demographics
NPI:1316329261
Name:PSYCHIATRY DELAWARE COMPANY LLC
Entity type:Organization
Organization Name:PSYCHIATRY DELAWARE COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:W
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-478-1450
Mailing Address - Street 1:1415 FOULK RD STE 104
Mailing Address - Street 2:FOULKSTONE PLAZA
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2748
Mailing Address - Country:US
Mailing Address - Phone:302-478-1450
Mailing Address - Fax:302-478-1430
Practice Address - Street 1:1415 FOULK RD STE 104
Practice Address - Street 2:FOULKSTONE PLAZA
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2748
Practice Address - Country:US
Practice Address - Phone:302-478-1450
Practice Address - Fax:302-478-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC200079312084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE220314Medicare PIN