Provider Demographics
NPI:1184600942
Name:INTERNAL MEDICINE OF DOVER PA
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF DOVER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:T
Authorized Official - Middle Name:NOBLE
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:302-678-4488
Mailing Address - Street 1:725 SOUTH QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904
Mailing Address - Country:US
Mailing Address - Phone:302-678-4488
Mailing Address - Fax:302-678-4497
Practice Address - Street 1:725 SOUTH QUEEN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-678-4488
Practice Address - Fax:302-678-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000178002Medicaid
053568Medicare ID - Type UnspecifiedMEDICARE GROUP