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General NPI Number Information
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NPI Number | 1043514797
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL CARE ASSOCIATES, LLC
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 2533 AUGUSTINE HERMAN HWY SUITE A
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City | CHESAPEAKE CITY
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State | MD
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Zip | 21915-1414
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Country | US
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Telephone | 302-378-6163
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Fax |
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Provider Business Mailing Address
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Address Line | 40 FREDERICKSBURG DR
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City | MIDDLETOWN
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State | DE
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Zip | 19709-3830
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Country | US
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Telephone | 302-378-6163
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | WILLIAM VIVIAN
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Credential |
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Telephone | 302-633-5840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C1-0009568
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License Number State | DE
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