Provider Demographics
NPI:1578566907
Name:MILLSBORO FAMILY PRACTICE, P.A.
Entity Type:Organization
Organization Name:MILLSBORO FAMILY PRACTICE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-934-7344
Mailing Address - Street 1:201 LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-1732
Mailing Address - Country:US
Mailing Address - Phone:302-934-7344
Mailing Address - Fax:302-934-7345
Practice Address - Street 1:201 LAUREL RD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-1732
Practice Address - Country:US
Practice Address - Phone:302-934-7344
Practice Address - Fax:302-934-7345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20005747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE87726OtherUNITED INS. CO.
DE54540001OtherDELMARVA HEALTH INS. CO.
DE876396OtherAETNA INS. CO.
DE890562OtherMAMSI INS. CO.
DE15039OtherMIDATLANTIC INS. CO.
DE187037OtherCOVENTRY INS. CO.
DE2208964001OtherAMERIHEALTH INS. CO.
DE6697853OtherCIGNA INS. CO.
DE23227OtherJOHNS HOPKINS INS. CO.
DE15039OtherMIDATLANTIC INS. CO.
DE=========OtherBCBSDE INS. CO.
DE6697853OtherCIGNA INS. CO.
DE87726OtherUNITED INS. CO.
DEG01028Medicare ID - Type Unspecified