Provider Demographics
NPI:1558677153
Name:DELAWARE MEDICAL GROUP
Entity Type:Organization
Organization Name:DELAWARE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ISLAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALJUNAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-653-1281
Mailing Address - Street 1:51 DEAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977
Mailing Address - Country:US
Mailing Address - Phone:302-653-1281
Mailing Address - Fax:
Practice Address - Street 1:51 DEAK DRIVE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977
Practice Address - Country:US
Practice Address - Phone:302-653-1281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10009459261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center