MEDICARE: DAGSBORO FAMILY PRACTICE, P.A.

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	C2-0002872	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437120110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAGSBORO FAMILY PRACTICE, P.A.

Provider Business Mailing Address
First Line	:	29475 VINES CREEK RD
Second Line	:
City	:	DAGSBORO
State	:	DE
Zip	:	19939-3839
Country	:	US
Telephone Number	:	302-732-9593
Fax Number	:	302-732-9598

Provider Business Practice Location Address
First Line	:	29475 VINES CREEK RD
Second Line	:
City	:	DAGSBORO
State	:	DE
Zip	:	19939-3839
Country	:	US
Telephone Number	:	302-732-9593
Fax Number	:	302-732-9598

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PRENTISS WAYNE ADKINS SR.
Credential	:	D.O.
Telephone Number	:	302-732-9593

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	10/17/2007

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Directions to “DAGSBORO FAMILY PRACTICE, P.A. ” Practice Location

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