Provider Demographics
NPI:1851346126
Name:PRIMARY CARE OF DELAWARE,LLC
Entity Type:Organization
Organization Name:PRIMARY CARE OF DELAWARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:VINEET
Authorized Official - Middle Name:
Authorized Official - Last Name:PURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-744-9645
Mailing Address - Street 1:1001 S BRADFORD ST
Mailing Address - Street 2:STE 9
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4153
Mailing Address - Country:US
Mailing Address - Phone:302-744-9645
Mailing Address - Fax:302-744-9649
Practice Address - Street 1:1001 S BRADFORD ST
Practice Address - Street 2:STE 9
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4153
Practice Address - Country:US
Practice Address - Phone:302-744-9645
Practice Address - Fax:302-744-9649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001179902Medicaid
DE0001179902Medicaid
DEG87725Medicare UPIN