=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972661502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONCORD MEDICAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 02/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 BAYNARD BLVD
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19802-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-777-5060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 BAYNARD BLVD
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19802-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-777-5060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CAREN LEE THOMPSON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 302-777-5060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | C10003417
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------