Provider Demographics
NPI:1265441331
Name:CENTRAL DELAWARE FAMILY MEDICINE PA
Entity type:Organization
Organization Name:CENTRAL DELAWARE FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:P
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-735-1616
Mailing Address - Street 1:1001 S BRADFORD ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4153
Mailing Address - Country:US
Mailing Address - Phone:302-735-1616
Mailing Address - Fax:302-735-1617
Practice Address - Street 1:1001 S BRADFORD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4153
Practice Address - Country:US
Practice Address - Phone:302-735-1616
Practice Address - Fax:302-735-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2005202181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DECC8811OtherRAILROAD MEDICARE
DE0000689602Medicaid
DE860705Medicare PIN