Provider Demographics
NPI:1982607677
Name:DELAWARE HEART GROUP PA
Entity type:Organization
Organization Name:DELAWARE HEART GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-225-3888
Mailing Address - Street 1:4735 OGLETOWN STANTON ROAD
Mailing Address - Street 2:MEDICAL ARTS PAVILION 2 SUITE 2123
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-504-1860
Mailing Address - Fax:302-504-1881
Practice Address - Street 1:4735 OGLETOWN STANTON ROAD
Practice Address - Street 2:MEDICAL ARTS PAVILION 2 SUITE 2123
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-504-1860
Practice Address - Fax:302-504-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10001668207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000070802Medicaid
DE0000070802Medicaid
MD054MMedicare PIN