Provider Demographics
NPI:1043755176
Name:CENTRAL DELAWARE FAMILY MEDICINE
Entity Type:Organization
Organization Name:CENTRAL DELAWARE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAZZE-MCILROY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-735-1616
Mailing Address - Street 1:1001 S BRADFORD ST
Mailing Address - Street 2:STE. 4
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4153
Mailing Address - Country:US
Mailing Address - Phone:302-735-1616
Mailing Address - Fax:302-735-1616
Practice Address - Street 1:1001 S BRADFORD ST
Practice Address - Street 2:STE. 4
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4153
Practice Address - Country:US
Practice Address - Phone:302-735-1616
Practice Address - Fax:302-735-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty