Provider Demographics
NPI:1326221524
Name:DELMARVA ORTHOTICS AND PROSTHETICS
Entity Type:Organization
Organization Name:DELMARVA ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCELLIGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:302-678-8311
Mailing Address - Street 1:30 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-7302
Mailing Address - Country:US
Mailing Address - Phone:302-678-8311
Mailing Address - Fax:302-678-8319
Practice Address - Street 1:30 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-7302
Practice Address - Country:US
Practice Address - Phone:302-678-8311
Practice Address - Fax:302-678-8319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000032289Medicaid
DE5157290001Medicare NSC