Basic Information
| Provider Information | |||||||||
| NPI: | 1659461390 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTHONY | ||||||||
| FirstName: | THIELE | ||||||||
| MiddleName: | UMALI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191 | ||||||||
| Address2: | PROVIDER ENROLLMENT DEPT | ||||||||
| City: | ROCKLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197320191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026516212 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Practice Location | |||||||||
| Address1: | 49 FALLON AVE. | ||||||||
| Address2: | NEMOURS PEDIATRICS SEAFORD | ||||||||
| City: | SEAFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199731577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026295030 | ||||||||
| FaxNumber: | 3026295035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 09/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | C10005390 | DE | N | Allopathic & Osteopathic Physicians | Pediatrics | 208D00000X | C10005390 | DE | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 101045716 | 05 | PA | MEDICAID | 7848901 | 05 | NJ | MEDICAID | 4433076 | 05 | MD | MEDICAID |