Provider Demographics
NPI:1982649638
Name:DELMED HEALTH
Entity Type:Organization
Organization Name:DELMED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-645-7036
Mailing Address - Street 1:431 SAVANNAH ROAD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1460
Mailing Address - Country:US
Mailing Address - Phone:302-644-9080
Mailing Address - Fax:302-644-9088
Practice Address - Street 1:431 SAVANNAH ROAD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1460
Practice Address - Country:US
Practice Address - Phone:302-644-9080
Practice Address - Fax:302-644-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1998210158207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001198602Medicaid
DEG00824Medicare PIN