Provider Demographics
NPI:1508899394
Name:HOME PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:HOME PHYSICIAN NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-832-5099
Mailing Address - Street 1:2443 MCCOY RD
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1931
Mailing Address - Country:US
Mailing Address - Phone:302-832-5099
Mailing Address - Fax:
Practice Address - Street 1:2443 MCCOY RD
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1931
Practice Address - Country:US
Practice Address - Phone:302-832-5099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000034715Medicaid
DE1000034715Medicaid