Basic Information
| Provider Information | |||||||||
| NPI: | 1851361224 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DELMAR EMERGENCY SPECIALISTS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3012 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004564629 | ||||||||
| FaxNumber: | 3022242848 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 BOW ST | ||||||||
| Address2: | |||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103984000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 08/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | ELLIS | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8004564629 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0000695102 | 05 | DE | MEDICAID | 0548700700 | 05 | MD | MEDICAID | F238 | 01 | MD | DC | OTHER |