Provider Demographics
NPI:1285826131
Name:FAMILY MEDICINE OF MIDDLETOWN, PA.
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF MIDDLETOWN, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MHAIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMEDKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-376-6761
Mailing Address - Street 1:209 E MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 E MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1449
Practice Address - Country:US
Practice Address - Phone:302-376-6761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty