Provider Demographics
NPI:1447234232
Name:DELAWARE MEDICAL CARE PA
Entity type:Organization
Organization Name:DELAWARE MEDICAL CARE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ISLAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:AL-JUNAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-653-1281
Mailing Address - Street 1:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977
Mailing Address - Country:US
Mailing Address - Phone:302-653-1281
Mailing Address - Fax:302-653-1283
Practice Address - Street 1:51 DEAK DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1268
Practice Address - Country:US
Practice Address - Phone:302-653-1281
Practice Address - Fax:302-653-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE082801525OtherTRICARE
G15530Medicare UPIN