Provider Demographics
NPI:1598925083
Name:DIABETIC CENTER AND ENDOCRINOLOGY OF DELMARVA
Entity Type:Organization
Organization Name:DIABETIC CENTER AND ENDOCRINOLOGY OF DELMARVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-546-0900
Mailing Address - Street 1:31575 WINTERPLACE PKWY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1882
Mailing Address - Country:US
Mailing Address - Phone:410-546-0900
Mailing Address - Fax:
Practice Address - Street 1:31575 WINTERPLACE PKWY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1882
Practice Address - Country:US
Practice Address - Phone:410-546-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization