Provider Demographics
NPI:1790831667
Name:ENDOCRINE ASSOCIATES PA
Entity Type:Organization
Organization Name:ENDOCRINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACE
Authorized Official - Phone:302-731-0606
Mailing Address - Street 1:4745 OGLETOWN STANTON ROAD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2067
Mailing Address - Country:US
Mailing Address - Phone:302-731-0606
Mailing Address - Fax:302-731-1656
Practice Address - Street 1:4745 OGLETOWN STANTON ROAD
Practice Address - Street 2:SUITE 208
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-731-0606
Practice Address - Fax:302-731-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10001669207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000021601Medicaid
DE94231OtherAETNA
DE0000072702Medicaid
DE94231OtherAETNA
DE0000021601Medicaid
DE=========OtherBLUE CROSS BLUE SHIELD