Provider Demographics
NPI:1205931326
Name:HOCKESSIN FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:HOCKESSIN FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WINGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-239-6200
Mailing Address - Street 1:724 YORKLYN RD
Mailing Address - Street 2:STE 125
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8731
Mailing Address - Country:US
Mailing Address - Phone:302-239-6200
Mailing Address - Fax:302-239-6238
Practice Address - Street 1:724 YORKLYN RD
Practice Address - Street 2:STE 125
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8731
Practice Address - Country:US
Practice Address - Phone:302-239-6200
Practice Address - Fax:302-239-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
080061743OtherRAILROAD MEDICARE