Provider Demographics
NPI:1376581363
Name:DELAWARE MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:DELAWARE MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:FELZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-633-1442
Mailing Address - Street 1:4512 KIRKWOOD HWY
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5123
Mailing Address - Country:US
Mailing Address - Phone:302-993-2453
Mailing Address - Fax:302-993-1393
Practice Address - Street 1:2006 LIMESTONE RD STE 3
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5553
Practice Address - Country:US
Practice Address - Phone:302-995-2090
Practice Address - Fax:302-995-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE207R00000X, 207RC0000X, 363LF0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001195402Medicaid
DEG00548Medicare UPIN