Basic Information
| Provider Information | |||||||||
| NPI: | 1396035374 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DELMARVA RADIOLOGY P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 918 EASTERN SHORE DR | ||||||||
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| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218046410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107491124 | ||||||||
| FaxNumber: | 4107491270 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 MIDDLEFORD RD | ||||||||
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| City: | SEAFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199733636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026291100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| AuthorizedOfficialLastName: | LIBBY | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4107491124 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.