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General NPI Number Information
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NPI Number | 1649727835
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Entity Type | Organization
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Legal Business Name | MID-DELAWARE FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 1673 S STATE ST STE A
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City | DOVER
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State | DE
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Zip | 19901-5148
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Country | US
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Telephone | 302-724-5125
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Fax |
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Provider Business Mailing Address
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Address Line | 1673 S STATE ST STE A
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City | DOVER
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State | DE
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Zip | 19901-5148
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Country | US
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Telephone | 302-724-5125
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CANDICE SHAH
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Credential | M.D.
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Telephone | 302-724-5125
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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 | C1-0008211
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License Number State | DE
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