Provider Demographics
NPI:1235282997
Name:DELAWARE DERMATOLOGY, P.A.
Entity Type:Organization
Organization Name:DELAWARE DERMATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-736-1800
Mailing Address - Street 1:737 S QUEEN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3529
Mailing Address - Country:US
Mailing Address - Phone:302-736-1800
Mailing Address - Fax:302-734-2769
Practice Address - Street 1:737 S QUEEN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3529
Practice Address - Country:US
Practice Address - Phone:302-736-1800
Practice Address - Fax:302-734-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1994107811207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000562402Medicaid
DEG02133Medicare ID - Type UnspecifiedGROUP NUMBER