Provider Demographics
NPI:1639195902
Name:JO ANN FIELDS MD
Entity Type:Organization
Organization Name:JO ANN FIELDS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-284-1169
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:DE
Mailing Address - Zip Code:19943-0615
Mailing Address - Country:US
Mailing Address - Phone:302-284-1169
Mailing Address - Fax:302-284-8827
Practice Address - Street 1:2 EAST HIGH ST
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:DE
Practice Address - Zip Code:19943
Practice Address - Country:US
Practice Address - Phone:302-284-1169
Practice Address - Fax:302-284-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000729701Medicaid
DE0000729701Medicaid
DEG00373Medicare ID - Type Unspecified