Provider Demographics
NPI:1710047915
Name:FAMILY PHYSICIANS OF WILMINGTON LLC
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS OF WILMINGTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-478-9191
Mailing Address - Street 1:2700 SILVERSIDE RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3719
Mailing Address - Country:US
Mailing Address - Phone:302-478-9191
Mailing Address - Fax:302-478-9193
Practice Address - Street 1:2700 SILVERSIDE RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3719
Practice Address - Country:US
Practice Address - Phone:302-478-9191
Practice Address - Fax:302-478-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2004211180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000039737Medicaid
G01813Medicare ID - Type Unspecified