Provider Demographics
NPI:1487609517
Name:TAMESIS RHEUMATOLOGY MEDICINE OF DELAWARE, P.A
Entity type:Organization
Organization Name:TAMESIS RHEUMATOLOGY MEDICINE OF DELAWARE, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CODING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-266-9166
Mailing Address - Street 1:1673 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-5148
Mailing Address - Country:US
Mailing Address - Phone:302-744-9040
Mailing Address - Fax:302-744-9046
Practice Address - Street 1:1673 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5148
Practice Address - Country:US
Practice Address - Phone:302-744-9040
Practice Address - Fax:302-744-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005967207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000032347Medicaid
DEG21045Medicare UPIN
DE1000032347Medicaid