Provider Demographics
NPI:1114935004
Name:DECKMANN, ROBERT C (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:DECKMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33663 BAYVIEW MEDICAL DR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1663
Mailing Address - Country:US
Mailing Address - Phone:302-645-3555
Mailing Address - Fax:302-644-3560
Practice Address - Street 1:33663 BAYVIEW MEDICAL DR
Practice Address - Street 2:UNIT 2
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1663
Practice Address - Country:US
Practice Address - Phone:302-645-9325
Practice Address - Fax:302-645-5214
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004606207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000638801Medicaid
DE0000638801Medicaid
121953E77Medicare ID - Type Unspecified