Provider Demographics
NPI:1417918970
Name:ARCHER, DONALD R JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:ARCHER
Suffix:JR
Gender:M
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:P.O. BOX 30170
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-7170
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4735 OGLETOWN STANTON RD
Practice Address - Street 2:STE 2210
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-623-4144
Practice Address - Fax:302-623-4147
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003877208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE9434147001OtherCIGNA HEALTH CARE
DE0000432101Medicaid
DE2114890OtherUNITED HEALTH CARE
DE2175979OtherAETNA
DE510110596OtherBCBS DE
DE021558C92Medicare PIN
F30829Medicare UPIN
003060P52Medicare ID - Type Unspecified