Provider Demographics
NPI:1164536322
Name:BANCROFT INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:BANCROFT INTERNAL MEDICINE PA
Other - Org Name:ROBERT G. ALTSCHULER, MD, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALTSCHULER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-652-3771
Mailing Address - Street 1:1806 N VAN BUREN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-3851
Mailing Address - Country:US
Mailing Address - Phone:302-652-3771
Mailing Address - Fax:302-652-3773
Practice Address - Street 1:1806 N VAN BUREN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-3851
Practice Address - Country:US
Practice Address - Phone:302-652-3771
Practice Address - Fax:302-652-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000079902Medicaid
DECK3039Medicare PIN
DE569440Medicare PIN