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General NPI Number Information
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NPI Number | 1578566907
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Entity Type | Organization
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Legal Business Name | MILLSBORO FAMILY PRACTICE, P.A.
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 LAUREL RD
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City | MILLSBORO
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State | DE
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Zip | 19966-1732
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Country | US
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Telephone | 302-934-7344
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Fax | 302-934-7345
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Provider Business Mailing Address
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Address Line | 201 LAUREL RD
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City | MILLSBORO
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State | DE
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Zip | 19966-1732
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Country | US
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Telephone | 302-934-7344
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Fax | 302-934-7345
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. LISA ANN MARTIN
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Credential | D.O.
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Telephone | 302-934-7344
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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 | C20005747
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License Number State | DE
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