| Fenwick Medical Center Pa | |
|
1400 Coastal Hwy Fenwick Island DE 19944 | |
| (302) 581-0458 | |
| (302) 581-0460 |
| Full Name | Fenwick Medical Center Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 1400 Coastal Hwy, Fenwick Island, Delaware |
| Authorized Official Name and Position | Nicholas Nicholson Borodulia (PRACTICE OWNER) |
| Authorized Official Contact | 3025810458 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fenwick Medical Center Pa 12036 S Piney Point Rd Bishopville MD 21813-1542 Ph: (410) 430-5154 | Fenwick Medical Center Pa 1400 Coastal Hwy Fenwick Island DE 19944 Ph: (302) 581-0458 |
| NPI Number | 1396780664 |
|---|---|
| Provider Enumeration Date | 06/19/2006 |
| Last Update Date | 09/24/2025 |
| Medicare PECOS PAC ID | 1355348889 |
|---|---|
| Medicare Enrollment ID | O20061026000117 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396780664 | NPI | - | NPPES |
| DG9614 | Other | DE | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | C10001802 (Delaware) | Primary |
| Provider Name | Nicholas N Borodulia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225004294 PECOS PAC ID: 6608873138 Enrollment ID: I20061026000181 |