Provider Demographics
NPI:1831143924
Name:WILMINGTON MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:WILMINGTON MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-478-0400
Mailing Address - Street 1:2700 SILVERSIDE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3719
Mailing Address - Country:US
Mailing Address - Phone:302-478-0400
Mailing Address - Fax:302-478-3827
Practice Address - Street 1:2700 SILVERSIDE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3719
Practice Address - Country:US
Practice Address - Phone:302-478-0400
Practice Address - Fax:302-478-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000613902Medicaid
311300OtherAETNA
DE110117904OtherRAILROAD
33558OtherUNITED HEALTHCARE
0123277000OtherAMERIHEALTH
110117904OtherRAILROAD MEDICATE
DE081738W38Medicare UPIN