Provider Demographics
NPI:1083003875
Name:DAVID S. ESTOCK M.D. P.A.
Entity Type:Organization
Organization Name:DAVID S. ESTOCK M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:ESTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-479-0100
Mailing Address - Street 1:1403 FOULK RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2788
Mailing Address - Country:US
Mailing Address - Phone:302-479-0100
Mailing Address - Fax:302-479-0177
Practice Address - Street 1:1403 FOULK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2788
Practice Address - Country:US
Practice Address - Phone:302-479-0100
Practice Address - Fax:302-479-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC-10003216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000157501Medicaid
DEB90167Medicare UPIN
DE0000157501Medicaid