Provider Demographics
NPI:1992294243
Name:NANTICOKE INTERNAL MEDICINE
Entity type:Organization
Organization Name:NANTICOKE INTERNAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SLOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-629-5217
Mailing Address - Street 1:1 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3300
Mailing Address - Country:US
Mailing Address - Phone:302-629-5348
Mailing Address - Fax:302-629-6570
Practice Address - Street 1:1 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3300
Practice Address - Country:US
Practice Address - Phone:302-629-5348
Practice Address - Fax:302-629-6570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE=========Medicaid