Provider Demographics
NPI:1407947880
Name:ATKINSON, AGUIDA C (MD)
Entity Type:Individual
Prefix:DR
First Name:AGUIDA
Middle Name:C
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:NEMOURS PEDIATRICS ST. FRANCIS
Practice Address - Street 2:7TH & CLAYTON STREET SUITE 400
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3165
Practice Address - Country:US
Practice Address - Phone:302-421-9700
Practice Address - Fax:302-421-9743
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004110208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1419510Medicaid
VA6703135Medicaid
NY01547093Medicaid
PA001447059Medicaid
NJ6078109Medicaid
PA001447059Medicaid
000940T34Medicare PIN