Provider Demographics
NPI:1528339108
Name:DELAWARE FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:DELAWARE FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GALICANO
Authorized Official - Middle Name:F
Authorized Official - Last Name:INGUITO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:302-473-1646
Mailing Address - Street 1:15 OMEGA DR BLDG K
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2057
Mailing Address - Country:US
Mailing Address - Phone:302-743-1646
Mailing Address - Fax:
Practice Address - Street 1:15 OMEGA DR BLDG K
Practice Address - Street 2:SUITE 3
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2057
Practice Address - Country:US
Practice Address - Phone:302-743-1646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1265446934Medicaid