Provider Demographics
NPI:1144308412
Name:CENTRAL DELAWARE FAMILY FOOT CARE
Entity type:Organization
Organization Name:CENTRAL DELAWARE FAMILY FOOT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GEMIGNANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:302-678-3338
Mailing Address - Street 1:1326 S GOVERNORS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4800
Mailing Address - Country:US
Mailing Address - Phone:302-678-3338
Mailing Address - Fax:302-678-5538
Practice Address - Street 1:1326 S GOVERNORS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4800
Practice Address - Country:US
Practice Address - Phone:302-678-3338
Practice Address - Fax:302-678-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000583317Medicaid
DE0000583317Medicaid
DEG01646Medicare ID - Type Unspecified