Healthcare Provider Details

I. General information

NPI: 1972661502
Provider Name (Legal Business Name): CONCORD MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BAYNARD BLVD
WILMINGTON DE
19802-3900
US

IV. Provider business mailing address

2100 BAYNARD BLVD
WILMINGTON DE
19802-3900
US

V. Phone/Fax

Practice location:
  • Phone: 302-777-5060
  • Fax:
Mailing address:
  • Phone: 302-777-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10003417
License Number StateDE

VIII. Authorized Official

Name: DR. CAREN LEE THOMPSON
Title or Position: OWNER
Credential: M.D.
Phone: 302-777-5060