Healthcare Provider Details

I. General information

NPI: 1396780664
Provider Name (Legal Business Name): FENWICK MEDICAL CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COASTAL HWY
FENWICK ISLAND DE
19944
US

IV. Provider business mailing address

12036 S PINEY POINT RD
BISHOPVILLE MD
21813-1542
US

V. Phone/Fax

Practice location:
  • Phone: 302-581-0458
  • Fax: 302-581-0460
Mailing address:
  • Phone: 410-430-5154
  • Fax: 410-352-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberC10001802
License Number StateDE

VIII. Authorized Official

Name: NICHOLAS NICHOLSON BORODULIA
Title or Position: PRACTICE OWNER
Credential:
Phone: 302-581-0458