Healthcare Provider Details
I. General information
NPI: 1871651380
Provider Name (Legal Business Name): DELAWARE MEDICAL ASSOCIATES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/05/2006
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2101 FOULK ROAD
WILMINGTON DE
19810
US
IV. Provider business mailing address
2101 FOULK ROAD
WILMINGTON DE
19810
US
V. Phone/Fax
- Phone: 302-475-3385
- Fax: 302-475-2720
- Phone: 302-475-3385
- Fax: 302-475-2720
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 111N00000X |
| Taxonomy | Chiropractor |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RC0000X |
| Taxonomy | Cardiovascular Disease Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
ARMAND
NEAL
DESANCTIS
JR.
Title or Position: OWNER/CEO
Credential: M.D.
Phone: 302-475-3385