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General NPI Number Information
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NPI Number | 1386662054
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Entity Type | Organization
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Legal Business Name | SOUTHERN DELAWARE MEDICAL GROUP, PA
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 100 SILICATO PKWY STE 301
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City | MILFORD
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State | DE
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Zip | 19963-1272
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Country | US
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Telephone | 302-725-2040
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Fax | 855-403-0778
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Provider Business Mailing Address
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Address Line | PO BOX 337
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City | MILFORD
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State | DE
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Zip | 19963-0337
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Country | US
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Telephone | 302-725-2040
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Fax | 855-403-0778
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | OLGA SAMARY GONZALEZ
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Credential |
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Telephone | 302-725-2040
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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 | C20006015
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License Number State | DE
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