Provider Demographics
NPI:1477561306
Name:CLINIC BY THE SEA LLC
Entity Type:Organization
Organization Name:CLINIC BY THE SEA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGES
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-644-0999
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:NASSAU
Mailing Address - State:DE
Mailing Address - Zip Code:19969-0323
Mailing Address - Country:US
Mailing Address - Phone:302-644-0999
Mailing Address - Fax:302-644-3099
Practice Address - Street 1:16337 COASTAL HWY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3607
Practice Address - Country:US
Practice Address - Phone:302-644-0999
Practice Address - Fax:302-644-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005201207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000015445Medicaid
G00854Medicare ID - Type Unspecified
DE1000015445Medicaid
G65050Medicare UPIN