Provider Demographics
NPI:1821155235
Name:JOHN F DECARLI DO
Entity Type:Organization
Organization Name:JOHN F DECARLI DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:DECARLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-761-9620
Mailing Address - Street 1:700 W LEA BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2500
Mailing Address - Country:US
Mailing Address - Phone:302-761-9620
Mailing Address - Fax:302-761-9625
Practice Address - Street 1:700 W LEA BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2500
Practice Address - Country:US
Practice Address - Phone:302-761-9620
Practice Address - Fax:302-761-9625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0002853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000099604Medicaid