Provider Demographics
NPI:1245370246
Name:KATHRYN L FORD FAMILY PRACTICE CENTER, L.L.C.
Entity type:Organization
Organization Name:KATHRYN L FORD FAMILY PRACTICE CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WENDELL
Authorized Official - Last Name:FORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:302-674-8088
Mailing Address - Street 1:870 SOUTH GOVENORS AVE.
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4108
Mailing Address - Country:US
Mailing Address - Phone:302-674-8088
Mailing Address - Fax:302-674-8213
Practice Address - Street 1:870 SOUTH GOVENORS AVE.
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4108
Practice Address - Country:US
Practice Address - Phone:302-674-8088
Practice Address - Fax:302-674-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty