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General NPI Number Information
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NPI Number | 1275672677
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Entity Type | Organization
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Legal Business Name | MID DELAWARE INTERNAL MEDICINE,PA
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 31 GOODEN AVE
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City | DOVER
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State | DE
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Zip | 19904-4143
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Country | US
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Telephone | 302-674-9141
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Fax | 302-674-5907
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Provider Business Mailing Address
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Address Line | 31 GOODEN AVE
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City | DOVER
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State | DE
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Zip | 19904-4143
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Country | US
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Telephone | 302-674-9141
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Fax | 302-674-5907
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DOROTHY L MARRINER
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Credential |
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Telephone | 302-674-9141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C1-0004573
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License Number State | DE
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