Healthcare Provider Details

I. General information

NPI: 1528463684
Provider Name (Legal Business Name): CAMDEN WALK-IN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 S DUPONT HWY SUITE 2
DOVER DE
19901
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: 302-698-1187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number2014606438
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014606438
License Number StateDE

VIII. Authorized Official

Name: RONNIE N DIEM
Title or Position: COO
Credential:
Phone: 302-698-1100