Healthcare Provider Details

I. General information

NPI: 1265487128
Provider Name (Legal Business Name): INTERNAL MEDICINE OF DELAWARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SLEEPY HOLLOW DR SUITE 101
MIDDLETOWN DE
19709-8894
US

IV. Provider business mailing address

102 SLEEPY HOLLOW DR SUITE 101
MIDDLETOWN DE
19709-8894
US

V. Phone/Fax

Practice location:
  • Phone: 302-376-9888
  • Fax: 302-376-9160
Mailing address:
  • Phone: 302-376-9888
  • Fax: 302-376-9160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number2005202434
License Number StateDE

VIII. Authorized Official

Name: DR. RODRIGO CORDERO TANCHANCO
Title or Position: OWNER
Credential: M.D.
Phone: 302-376-9888