Provider Demographics
NPI:1659461390
Name:ANTHONY, THIELE UMALI (MD)
Entity Type:Individual
Prefix:DR
First Name:THIELE
Middle Name:UMALI
Last Name:ANTHONY
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:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:49 FALLON AVE.
Practice Address - Street 2:NEMOURS PEDIATRICS SEAFORD
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-1577
Practice Address - Country:US
Practice Address - Phone:302-629-5030
Practice Address - Fax:302-629-5035
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005390208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101045716Medicaid
NJ7848901Medicaid
MD4433076Medicaid
NJ7848901Medicaid
003003T34Medicare PIN