Provider Demographics
NPI:1427156769
Name:IANNI, CAROLYN OHARA (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:OHARA
Last Name:IANNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:OHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 FOULK RD
Mailing Address - Street 2:
Mailing Address - City:WILMINTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810
Mailing Address - Country:US
Mailing Address - Phone:302-475-2535
Mailing Address - Fax:302-475-2720
Practice Address - Street 1:5311 LIMESTONE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-234-2200
Practice Address - Fax:302-234-2262
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1006524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000610101Medicaid
DE0000610101Medicaid
H80226Medicare UPIN