Healthcare Provider Details

I. General information

NPI: 1487394516
Provider Name (Legal Business Name): MAI THANH LAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 KENNETT PIKE STE 230
WILMINGTON DE
19807-3019
US

IV. Provider business mailing address

3506 KENNETT PIKE STE 230
WILMINGTON DE
19807-3019
US

V. Phone/Fax

Practice location:
  • Phone: 302-661-3400
  • Fax: 302-656-5611
Mailing address:
  • Phone: 302-661-3400
  • Fax: 302-656-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC2-0024925
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC2-0024925
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: