Provider Demographics
NPI:1851544035
Name:THREE RV MEDICAL, LLC
Entity Type:Organization
Organization Name:THREE RV MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORINO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-536-7740
Mailing Address - Street 1:1330 MIDDLEFORD RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3648
Mailing Address - Country:US
Mailing Address - Phone:302-536-7740
Mailing Address - Fax:302-536-7742
Practice Address - Street 1:1330 MIDDLEFORD RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3648
Practice Address - Country:US
Practice Address - Phone:302-536-7740
Practice Address - Fax:302-536-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005026207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE00649M11Medicare PIN