| State Of Delaware | |
|
417 Federal St Dover DE 19901-3635 | |
| (302) 744-4849 | |
| (302) 739-1613 |
| Full Name | State Of Delaware |
|---|---|
| Speciality | Public Health or Welfare |
| Location | 417 Federal St, Dover, Delaware |
| Authorized Official Name and Position | Steven L Blessing (DIVISION DIRECTOR) |
| Authorized Official Contact | 3027444700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Delaware 417 Federal St Dover DE 19901-3635 Ph: (302) 744-4861 | State Of Delaware 417 Federal St Dover DE 19901-3635 Ph: (302) 744-4849 |
| NPI Number | 1013089895 |
|---|---|
| Provider Enumeration Date | 11/15/2006 |
| Last Update Date | 11/06/2025 |
| Medicare PECOS PAC ID | 6507756731 |
|---|---|
| Medicare Enrollment ID | O20241016001309 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013089895 | NPI | - | NPPES |
| 0000117554 | Medicaid | DE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 251K00000X | Public Health Or Welfare | (* (Not Available)) | Primary |
| Provider Name | Awele N Maduka-ezeh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114130069 PECOS PAC ID: 6002961539 Enrollment ID: I20120209000216 |
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State Of Delaware Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 417 Federal St, Dover, DE 19901 Phone: 302-744-4548 Fax: 302-739-1613 |