Provider Demographics
NPI:1699712786
Name:DELAWARE PHYSICIAN ASSOCIATES
Entity type:Organization
Organization Name:DELAWARE PHYSICIAN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-762-0200
Mailing Address - Street 1:4011 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2219
Mailing Address - Country:US
Mailing Address - Phone:302-762-0200
Mailing Address - Fax:302-762-0500
Practice Address - Street 1:4011 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2219
Practice Address - Country:US
Practice Address - Phone:302-762-0200
Practice Address - Fax:302-762-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE5253610001Medicare NSC
DEG00245Medicare PIN