Provider Demographics
NPI:1639488190
Name:WILMINGTON FAMILY PHYSICIANS PA
Entity Type:Organization
Organization Name:WILMINGTON FAMILY PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:VISSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-792-9925
Mailing Address - Street 1:4141 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6156
Mailing Address - Country:US
Mailing Address - Phone:910-792-9925
Mailing Address - Fax:
Practice Address - Street 1:2560 S 41ST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5527
Practice Address - Country:US
Practice Address - Phone:910-792-9925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty