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General NPI Number Information
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NPI Number | 1265487128
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE OF DELAWARE, LLC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 102 SLEEPY HOLLOW DR SUITE 101
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City | MIDDLETOWN
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State | DE
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Zip | 19709-8894
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Country | US
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Telephone | 302-376-9888
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Fax | 302-376-9160
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Provider Business Mailing Address
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Address Line | 102 SLEEPY HOLLOW DR SUITE 101
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City | MIDDLETOWN
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State | DE
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Zip | 19709-8894
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Country | US
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Telephone | 302-376-9888
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Fax | 302-376-9160
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Authorized Official
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Title or Position | OWNER
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Name | DR. RODRIGO CORDERO TANCHANCO
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Credential | M.D.
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Telephone | 302-376-9888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2005202434
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License Number State | DE
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