Healthcare Provider Details

I. General information

NPI: 1891357760
Provider Name (Legal Business Name): ESSENTIALS MEDICAL GROUP DE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 LANCASTER PIKE STE 301
WILMINGTON DE
19805-1511
US

IV. Provider business mailing address

3700 LANCASTER PIKE STE 301
WILMINGTON DE
19805-1511
US

V. Phone/Fax

Practice location:
  • Phone: 772-260-5648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCEE SCOTT
Title or Position: OWNER
Credential:
Phone: 772-260-5648