Provider Demographics
NPI:1033292016
Name:AFFORDABLE HEALTH CARE OF DELAWARE
Entity Type:Organization
Organization Name:AFFORDABLE HEALTH CARE OF DELAWARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEFINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-653-0903
Mailing Address - Street 1:224 N DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1511
Mailing Address - Country:US
Mailing Address - Phone:302-653-0903
Mailing Address - Fax:302-653-1708
Practice Address - Street 1:224 N DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1511
Practice Address - Country:US
Practice Address - Phone:302-653-0903
Practice Address - Fax:302-653-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG0005169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250067159OtherALLIANCE/OPT CHOICE/MAMSI
DEDB3857OtherRAILROAD MEDICARE
DE1000024006OtherDELAWARE PHYSICANS CARE
DE1000024006Medicaid
DE7048597OtherAETNA
DE2284181000OtherAMERIHEALTH
DE=========OtherBCBS DE
DE=========OtherCOVENTRY
DE7048597OtherAETNA
DE=========OtherTRICARE
DE=========OtherBCBS DE