Provider Demographics
NPI:1407036080
Name:DELAWARE FAMILY PRACTICE
Entity type:Organization
Organization Name:DELAWARE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:STAHR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-363-1304
Mailing Address - Street 1:377 E WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-2157
Mailing Address - Country:US
Mailing Address - Phone:740-363-1304
Mailing Address - Fax:740-549-7105
Practice Address - Street 1:377 E WILLIAM ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2157
Practice Address - Country:US
Practice Address - Phone:740-363-1304
Practice Address - Fax:740-549-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9237421Medicare PIN