Provider Demographics
NPI:1437185550
Name:NANTICOKE GYN ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:NANTICOKE GYN ASSOCIATES, P.A.
Other - Org Name:NANTICOKE OBGYN ASSOCIATES, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:RUPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-629-2434
Mailing Address - Street 1:10 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-9768
Mailing Address - Country:US
Mailing Address - Phone:302-629-2434
Mailing Address - Fax:302-629-2459
Practice Address - Street 1:105 N FRONT ST
Practice Address - Street 2:SUITE B NANTICOKE GYN ASSOC, PA
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-2707
Practice Address - Country:US
Practice Address - Phone:302-629-2434
Practice Address - Fax:302-629-2459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002432207VG0400X
DELH0000104363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE35303201OtherCAREFIRST MD
DE4273333OtherAETNA
DEG01061OtherMEDICARE
DE000000208474OtherUNISON
DE2089756000OtherAMERIHEALTH
DE2197629OtherCIGNA
DE0000020301Medicaid
DE26408OtherCOVENTRY
DE315676OtherMAMSI PLANS
DE=========OtherTRICARE/ CHAMPUS
DEG01061OtherMEDICARE
DE4273333OtherAETNA
DE=========OtherTRICARE/ CHAMPUS