Provider Demographics
NPI:1588717409
Name:DELAWARE PEDIATRICS
Entity type:Organization
Organization Name:DELAWARE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-449-2572
Mailing Address - Street 1:1202 FOULK RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2796
Mailing Address - Country:US
Mailing Address - Phone:302-449-2572
Mailing Address - Fax:
Practice Address - Street 1:1202 FOULK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2796
Practice Address - Country:US
Practice Address - Phone:302-449-2572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1994105452208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000024029Medicaid
DE0000572701Medicaid
DE0000537901Medicaid
DEP00011Medicare UPIN
DE1000024029Medicaid
DE0000537901Medicaid