Provider Demographics
NPI:1205839164
Name:MID-ATLANTIC FAMILY PRACTICE
Entity Type:Organization
Organization Name:MID-ATLANTIC FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-644-6860
Mailing Address - Street 1:20251 JOHN J WILLIAMS HWY
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4314
Mailing Address - Country:US
Mailing Address - Phone:302-644-6860
Mailing Address - Fax:302-644-6872
Practice Address - Street 1:20251 JOHN J WILLIAMS HWY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4314
Practice Address - Country:US
Practice Address - Phone:302-644-6860
Practice Address - Fax:302-644-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2003109879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01368Medicare PIN