Provider Demographics
NPI:1639275274
Name:QUALITY FAMILY PHYSICIANS, PA
Entity type:Organization
Organization Name:QUALITY FAMILY PHYSICIANS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIVENTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-235-2351
Mailing Address - Street 1:722 YORKLYN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8718
Mailing Address - Country:US
Mailing Address - Phone:302-235-2351
Mailing Address - Fax:302-235-2365
Practice Address - Street 1:722 YORKLYN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8718
Practice Address - Country:US
Practice Address - Phone:302-235-2351
Practice Address - Fax:302-235-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000023592Medicaid
DE1891794186OtherBK NPI
DE1821097114OtherKW NPI
DECK7837OtherRAILROAD MEDICARE GROUP
1861554271OtherEK NPI
DE0000944501Medicaid
DE1861554271Medicaid
DECK7837OtherRAILROAD MEDICARE GROUP
DE1821097114OtherKW NPI
DEG74626Medicare UPIN
DE00L25Q65Medicare ID - Type UnspecifiedKW MEDICARE
130514ZAHSMedicare PIN