Provider Demographics
NPI:1265487128
Name:INTERNAL MEDICINE OF DELAWARE, LLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF DELAWARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:CORDERO
Authorized Official - Last Name:TANCHANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-376-9888
Mailing Address - Street 1:102 SLEEPY HOLLOW DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-8894
Mailing Address - Country:US
Mailing Address - Phone:302-376-9888
Mailing Address - Fax:302-376-9160
Practice Address - Street 1:102 SLEEPY HOLLOW DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-8894
Practice Address - Country:US
Practice Address - Phone:302-376-9888
Practice Address - Fax:302-376-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2005202434261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG01968Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER