Provider Demographics
NPI:1649226200
Name:INTEGRATED CARE OF DOVER PA
Entity Type:Organization
Organization Name:INTEGRATED CARE OF DOVER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-735-7780
Mailing Address - Street 1:29 GOODEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4143
Mailing Address - Country:US
Mailing Address - Phone:302-735-7780
Mailing Address - Fax:302-735-7781
Practice Address - Street 1:29 GOODEN AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4143
Practice Address - Country:US
Practice Address - Phone:302-735-7780
Practice Address - Fax:302-735-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G76435Medicare UPIN