Healthcare Provider Details

I. General information

NPI: 1568975977
Provider Name (Legal Business Name): UMER FAROOQ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST STE 1E40
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

501 W 14TH ST STE 1E40
WILMINGTON DE
19801-1013
US

V. Phone/Fax

Practice location:
  • Phone: 302-320-2100
  • Fax: 302-320-2121
Mailing address:
  • Phone: 302-320-2100
  • Fax: 302-320-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0095315
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL82578
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD479418
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberD0095315
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD479418
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberC1-0028390
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: