Provider Demographics
NPI:1841299906
Name:SQUIRES, NANCY (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32335 DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:DAGSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19939
Mailing Address - Country:US
Mailing Address - Phone:302-732-8400
Mailing Address - Fax:302-732-8404
Practice Address - Street 1:32335 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:DAGSBORO
Practice Address - State:DE
Practice Address - Zip Code:19939
Practice Address - Country:US
Practice Address - Phone:302-732-8400
Practice Address - Fax:302-732-8404
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0003883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000406301Medicaid
MD544061100Medicaid
E17144Medicare UPIN
MD544061100Medicaid