Healthcare Provider Details

I. General information

NPI: 1790878049
Provider Name (Legal Business Name): FRIENDS & FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35141 ATLANTIC AVE UNIT 1
MILLVILLE DE
19967-6954
US

IV. Provider business mailing address

35141 ATLANTIC AVE UNIT 1
MILLVILLE DE
19967-6954
US

V. Phone/Fax

Practice location:
  • Phone: 302-537-3740
  • Fax: 302-537-3744
Mailing address:
  • Phone: 302-537-3740
  • Fax: 302-537-3744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2001107039
License Number StateDE

VIII. Authorized Official

Name: KIMBERLY GALLAGHER
Title or Position: OWNER
Credential: M.D,
Phone: 302-537-3740