Provider Demographics
NPI:1598857799
Name:CHILDERS, MARIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-1628
Mailing Address - Country:US
Mailing Address - Phone:302-684-0561
Mailing Address - Fax:302-684-3563
Practice Address - Street 1:424 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-1628
Practice Address - Country:US
Practice Address - Phone:302-684-0561
Practice Address - Fax:302-684-3563
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10009587208000000X
PAMD073832L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH46680Medicare UPIN