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General NPI Number Information
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NPI Number | 1609073493
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Entity Type | Organization
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Legal Business Name | HERITAGE MEDICAL ASSOCIATES, P.A.
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 2601 ANNAND DR STE 4 HERITAGE PROFESSIONAL CENTER
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City | WILMINGTON
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State | DE
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Zip | 19808-3719
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Country | US
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Telephone | 302-998-3334
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 ANNAND DR STE 4 HERITAGE PROFESSIONAL CENTER
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City | WILMINGTON
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State | DE
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Zip | 19808-3719
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Country | US
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Telephone | 302-998-3334
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Fax | 302-998-8985
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN VICTOR FENICE
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Credential | M.D.
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Telephone | 302-998-3336
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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 | C1-00007714
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License Number State | DE
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