Provider Demographics
NPI:1497786560
Name:DOVER FAMILY PHYSICIANS PA
Entity Type:Organization
Organization Name:DOVER FAMILY PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBACKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-734-7796
Mailing Address - Street 1:1342 S GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4804
Mailing Address - Country:US
Mailing Address - Phone:302-734-2500
Mailing Address - Fax:302-734-7758
Practice Address - Street 1:1342 S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4804
Practice Address - Country:US
Practice Address - Phone:302-734-2500
Practice Address - Fax:302-734-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE043805OtherMEDICARE PTAN