Provider Demographics
NPI:1780780627
Name:SOUTHERN DELAWARE IMAGING ASSOC
Entity type:Organization
Organization Name:SOUTHERN DELAWARE IMAGING ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-645-3636
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:NASSAU
Mailing Address - State:DE
Mailing Address - Zip Code:19969-0097
Mailing Address - Country:US
Mailing Address - Phone:302-645-7919
Mailing Address - Fax:302-645-7841
Practice Address - Street 1:424 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1462
Practice Address - Country:US
Practice Address - Phone:302-645-7919
Practice Address - Fax:302-645-7841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000204702Medicaid
DE503824Medicare ID - Type UnspecifiedMEDICARE