Provider Demographics
NPI:1811128242
Name:DELAWARE PEDORTHICS
Entity type:Organization
Organization Name:DELAWARE PEDORTHICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDORTHIST
Authorized Official - Prefix:
Authorized Official - First Name:VON
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:HOMER
Authorized Official - Suffix:
Authorized Official - Credentials:BOCPD
Authorized Official - Phone:302-230-3065
Mailing Address - Street 1:5321 BRANDYWINE PKWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-1471
Mailing Address - Country:US
Mailing Address - Phone:302-230-3065
Mailing Address - Fax:302-230-3045
Practice Address - Street 1:5321 BRANDYWINE PKWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1471
Practice Address - Country:US
Practice Address - Phone:302-230-3065
Practice Address - Fax:302-230-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier