Provider Demographics
NPI:1841231149
Name:CHRISTIANA MEDICAL GROUP, PA
Entity Type:Organization
Organization Name:CHRISTIANA MEDICAL GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-398-3868
Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 2201
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:410-398-3868
Mailing Address - Fax:410-392-9289
Practice Address - Street 1:4735 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 2201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2072
Practice Address - Country:US
Practice Address - Phone:410-398-3868
Practice Address - Fax:410-392-9289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DECD0294OtherMEDICARE RAILROAD GROUP
DE0000703702Medicaid
DE0000703702Medicaid
DECD0294OtherMEDICARE RAILROAD GROUP