Provider Demographics
NPI:1992740906
Name:DELMARVA RADIATION SERVICES, PA
Entity type:Organization
Organization Name:DELMARVA RADIATION SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COSTLEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-645-3775
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-0497
Mailing Address - Country:US
Mailing Address - Phone:302-645-3775
Mailing Address - Fax:302-645-3774
Practice Address - Street 1:18947 JOHN J WILLIAMS HWY
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4474
Practice Address - Country:US
Practice Address - Phone:302-645-3775
Practice Address - Fax:302-645-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000038787Medicaid
DE4449OtherRAILROAD MEDICARE
DE1000038787Medicaid