Provider Demographics
NPI:1811977093
Name:BRICE, JOANNE (MD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:BRICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:MAP 2, SUITE 2201
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:302-366-1868
Mailing Address - Fax:302-366-8572
Practice Address - Street 1:4735 OGLETOWN STANTON RD
Practice Address - Street 2:MAP 2, SUITE 2201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2072
Practice Address - Country:US
Practice Address - Phone:302-366-1868
Practice Address - Fax:302-366-8572
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006247207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001122301Medicaid
007953C37Medicare ID - Type Unspecified
DE0001122301Medicaid