Provider Demographics
NPI:1164692240
Name:OCEAN MEDICAL IMAGING OF DELAWARE, INC.
Entity Type:Organization
Organization Name:OCEAN MEDICAL IMAGING OF DELAWARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-684-5151
Mailing Address - Street 1:611 FEDERAL ST STE 4
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-1157
Mailing Address - Country:US
Mailing Address - Phone:302-684-5151
Mailing Address - Fax:302-684-1977
Practice Address - Street 1:611 FEDERAL ST STE 4
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-1157
Practice Address - Country:US
Practice Address - Phone:302-684-5151
Practice Address - Fax:302-684-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
DEC1-0004811261QR0200X, 261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MammographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE200064773Medicaid