Provider Demographics
NPI:1164561833
Name:DELMARVA BARIATRIC CENTER, P.A.
Entity Type:Organization
Organization Name:DELMARVA BARIATRIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOFRONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-341-6180
Mailing Address - Street 1:1324 BELMONT AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-4543
Mailing Address - Country:US
Mailing Address - Phone:410-341-6180
Mailing Address - Fax:410-341-6190
Practice Address - Street 1:1324 BELMONT AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4543
Practice Address - Country:US
Practice Address - Phone:410-341-6180
Practice Address - Fax:410-341-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052198174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD330MMedicare ID - Type Unspecified