1871651380 NPI number — DELAWARE MEDICAL ASSOCIATES P.A.

Table of content: (NPI 1871651380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871651380 NPI number — DELAWARE MEDICAL ASSOCIATES P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELAWARE MEDICAL ASSOCIATES P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR. ARMAND NEAL DESANCTIS JR MD
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871651380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 FOULK ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-475-3385
Provider Business Mailing Address Fax Number:
302-475-2720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 FOULK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-475-3385
Provider Business Practice Location Address Fax Number:
302-475-2720
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DESANCTIS
Authorized Official First Name:
ARMAND
Authorized Official Middle Name:
NEAL
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
302-475-3385

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000062300L , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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