Healthcare Provider Details

I. General information

NPI: 1851796916
Provider Name (Legal Business Name): CAMDEN PRIMARY CARE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 S DUPONT HWY SUITE 2
DOVER DE
19901-6405
US

IV. Provider business mailing address

4601 S DUPONT HWY SUITE 2
DOVER DE
19901-6405
US

V. Phone/Fax

Practice location:
  • Phone: 302-698-1100
  • Fax:
Mailing address:
  • Phone: 302-698-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number2014606439
License Number StateDE

VIII. Authorized Official

Name: MR. JOHN THOMAS PEARSON
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP
Phone: 302-698-1100