Provider Demographics
NPI:1629187646
Name:PSYCHIATRIC ACCESS FOR CENTRAL DELAWARE, P.A.
Entity type:Organization
Organization Name:PSYCHIATRIC ACCESS FOR CENTRAL DELAWARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:BORER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-674-2265
Mailing Address - Street 1:846 WALKER RD
Mailing Address - Street 2:STE. 32-2
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2756
Mailing Address - Country:US
Mailing Address - Phone:302-674-2265
Mailing Address - Fax:302-674-3321
Practice Address - Street 1:846 WALKER RD
Practice Address - Street 2:STE. 32-2
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2756
Practice Address - Country:US
Practice Address - Phone:302-674-2265
Practice Address - Fax:302-674-3321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1989031835261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1-000006241Medicaid
DE1-000006241Medicaid