Provider Demographics
NPI:1043514797
Name:FAMILY MEDICAL CARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-633-5840
Mailing Address - Street 1:40 FREDERICKSBURG DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-3830
Mailing Address - Country:US
Mailing Address - Phone:302-378-6163
Mailing Address - Fax:
Practice Address - Street 1:2533 AUGUSTINE HERMAN HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CHESAPEAKE CITY
Practice Address - State:MD
Practice Address - Zip Code:21915-1414
Practice Address - Country:US
Practice Address - Phone:302-378-6163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0009568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty