Provider Demographics
NPI:1972649556
Name:NANTICOKE SURGICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:NANTICOKE SURGICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-629-8662
Mailing Address - Street 1:543 N SHIPLEY ST
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-2339
Mailing Address - Country:US
Mailing Address - Phone:302-629-8662
Mailing Address - Fax:302-629-7661
Practice Address - Street 1:543 N SHIPLEY ST
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-2339
Practice Address - Country:US
Practice Address - Phone:302-629-8662
Practice Address - Fax:302-629-7661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1989027203208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE99032OtherAETNA
DE0000137502Medicaid
DE0108680000OtherAMERIHEALTH HMO
DECE2117OtherRAILROAD MEDICARE
DE487744OtherAMERIHEALTH PERSONAL CHOI
DE792499OtherMDIPA
DE0000137502Medicaid
DE99032OtherAETNA
DECE2117OtherRAILROAD MEDICARE