MEDICARE: FAMILY MEDICAL CARE ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	C1-0009568	DE

General Provider Information

NPI Number	:	1043514797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL CARE ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	40 FREDERICKSBURG DR
Second Line	:
City	:	MIDDLETOWN
State	:	DE
Zip	:	19709-3830
Country	:	US
Telephone Number	:	302-378-6163
Fax Number	:

Provider Business Practice Location Address
First Line	:	2533 AUGUSTINE HERMAN HWY
Second Line	:	SUITE A
City	:	CHESAPEAKE CITY
State	:	MD
Zip	:	21915-1414
Country	:	US
Telephone Number	:	302-378-6163
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	WILLIAM VIVIAN
Credential	:
Telephone Number	:	302-633-5840

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	01/10/2011

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