Provider Demographics
NPI:1063452928
Name:DELAWARE ORTHOPAEDICS AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:DELAWARE ORTHOPAEDICS AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-730-0840
Mailing Address - Street 1:230 BEISER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7793
Mailing Address - Country:US
Mailing Address - Phone:302-730-0840
Mailing Address - Fax:302-730-3006
Practice Address - Street 1:230 BEISER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7793
Practice Address - Country:US
Practice Address - Phone:302-730-0840
Practice Address - Fax:302-730-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1004912207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000025134Medicaid
DE0000762501Medicaid
DEG41670Medicare UPIN
DE0000762501Medicaid