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General NPI Number Information
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NPI Number | 1992294243
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Entity Type | Organization
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Legal Business Name | NANTICOKE INTERNAL MEDICINE
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 1 CEDAR AVE
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City | SEAFORD
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State | DE
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Zip | 19973-3300
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Country | US
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Telephone | 302-629-5348
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Fax | 302-629-6570
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Provider Business Mailing Address
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Address Line | 1 CEDAR AVE
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City | SEAFORD
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State | DE
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Zip | 19973-3300
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Country | US
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Telephone | 302-629-5348
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Fax | 302-629-6570
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Authorized Official
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Title or Position | DIRECTOR
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Name | SLOAN TRAMMELL
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Credential |
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Telephone | 302-629-5217
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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 |
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License Number State |
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