Provider Demographics
NPI:1871762831
Name:DELAWARE INTERNAL MEDICINE
Entity type:Organization
Organization Name:DELAWARE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-369-1010
Mailing Address - Street 1:454 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1486
Mailing Address - Country:US
Mailing Address - Phone:740-369-1010
Mailing Address - Fax:
Practice Address - Street 1:454 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1486
Practice Address - Country:US
Practice Address - Phone:740-369-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHD4932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0421556Medicaid
OH9931681Medicare PIN