MEDICARE: WILMINGTON OTOLARYNGOLOGY ASSOCIATES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	1989016985	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518902451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILMINGTON OTOLARYNGOLOGY ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	2300 PENNSYLVANIA AVE
Second Line	:	SUITE 2A
City	:	WILMINGTON
State	:	DE
Zip	:	19806-1392
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 PENNSYLVANIA AVE
Second Line	:	SUITE 2A
City	:	WILMINGTON
State	:	DE
Zip	:	19806-1392
Country	:	US
Telephone Number	:	302-658-0404
Fax Number	:

Authorized Official
Title or Position	:	PRES
Name	:	WILLIAM L. MEDFORD
Credential	:	MD
Telephone Number	:	302-658-0404

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	12/16/2015

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