Provider Demographics
NPI:1902840226
Name:FAMILY MEDICAL ASSOCIATES OF DELAWARE
Entity Type:Organization
Organization Name:FAMILY MEDICAL ASSOCIATES OF DELAWARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAKAN KARLO
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAGAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-655-0355
Mailing Address - Street 1:2300 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1392
Mailing Address - Country:US
Mailing Address - Phone:302-655-0355
Mailing Address - Fax:302-655-4833
Practice Address - Street 1:2300 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1392
Practice Address - Country:US
Practice Address - Phone:302-655-0355
Practice Address - Fax:302-655-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000040440Medicaid
DEG02351Medicare ID - Type Unspecified