MEDICARE: DR. ANDREW H DEMICHELE MD

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	208600000X	Surgery Physician	MD058617L	PA
2	208600000X	Surgery Physician	C10007635	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0005353635	OTHER	PA	AETNA PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0005353635	OTHER	DE	AETNA PIN

General Provider Information

NPI Number	:	1902817018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW H DEMICHELE MD

Provider Business Mailing Address
First Line	:	PO BOX 8157
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19803-8157
Country	:	US
Telephone Number	:	302-652-6050
Fax Number	:	302-652-6053

Provider Business Practice Location Address
First Line	:	1500 SHALLCROSS AVE
Second Line	:	SUITE 1 A
City	:	WILMINGTON
State	:	DE
Zip	:	19806-3037
Country	:	US
Telephone Number	:	302-652-6050
Fax Number	:	302-652-6053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	01/08/2016

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