MEDICARE: FENWICK MEDICAL CENTER PA

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
2	261QP2300X	Primary Care Clinic/Center	C10001802	DE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DG9614	OTHER	DE	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1396780664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FENWICK MEDICAL CENTER PA

Provider Business Mailing Address
First Line	:	12036 S PINEY POINT RD
Second Line	:
City	:	BISHOPVILLE
State	:	MD
Zip	:	21813-1542
Country	:	US
Telephone Number	:	410-430-5154
Fax Number	:	410-352-5430

Provider Business Practice Location Address
First Line	:	1400 COASTAL HWY
Second Line	:
City	:	FENWICK ISLAND
State	:	DE
Zip	:	19944
Country	:	US
Telephone Number	:	302-581-0458
Fax Number	:	302-581-0460

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	NICHOLAS NICHOLSON BORODULIA
Credential	:
Telephone Number	:	302-581-0458

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	09/24/2025

Similar Medicare Providers

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Practice Location Address:

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Practice Location Address:

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1194181727 — MRS. MARY H STRONG
Practice Location Address:

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1609023092 — BRANDYWINE ASSISTED LIVING AT FENWICK ISLAND, LLC
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1831587989 — MRS. JANET LEIGH VAUGHN CRNA
Practice Location Address:

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Practice Fax:

Directions to “FENWICK MEDICAL CENTER PA ” Practice Location

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