Provider Demographics
NPI:1962437459
Name:MAURICE A.THEW M.D., P.A.
Entity type:Organization
Organization Name:MAURICE A.THEW M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:THEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-478-1213
Mailing Address - Street 1:PO BOX 3012
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-0012
Mailing Address - Country:US
Mailing Address - Phone:302-224-5678
Mailing Address - Fax:302-224-2848
Practice Address - Street 1:19 THE COMMONS
Practice Address - Street 2:3516 SILVERSIDE ROAD
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4932
Practice Address - Country:US
Practice Address - Phone:302-478-1213
Practice Address - Fax:302-478-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000209002Medicaid