Provider Demographics
NPI:1558900126
Name:DELAWARE WALK-IN MEDICAL, LLC
Entity Type:Organization
Organization Name:DELAWARE WALK-IN MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZEBUN
Authorized Official - Middle Name:
Authorized Official - Last Name:NISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-607-5147
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-0188
Mailing Address - Country:US
Mailing Address - Phone:302-607-5147
Mailing Address - Fax:
Practice Address - Street 1:379 WALMART DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934-1365
Practice Address - Country:US
Practice Address - Phone:302-698-4441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELAWARE WALK IN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty