| Shore Community Medical Llc | |
|
18947 John J Williams Hwy Suite 306 Rehoboth Beach DE 19971-4474 | |
| (302) 827-4365 | |
| (302) 827-4359 |
| Full Name | Shore Community Medical Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 18947 John J Williams Hwy, Rehoboth Beach, Delaware |
| Authorized Official Name and Position | Thomas Francis Kelly (MEMBER) |
| Authorized Official Contact | 3028274365 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shore Community Medical Llc 18947 John J Williams Hwy Suite Number 306 Rehoboth Beach DE 19971-4474 Ph: (302) 827-4365 | Shore Community Medical Llc 18947 John J Williams Hwy Suite 306 Rehoboth Beach DE 19971-4474 Ph: (302) 827-4365 |
| NPI Number | 1740561778 |
|---|---|
| Provider Enumeration Date | 09/04/2011 |
| Last Update Date | 01/12/2012 |
| Medicare PECOS PAC ID | 8820260904 |
|---|---|
| Medicare Enrollment ID | O20111014000071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740561778 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | C10006041 (Delaware) | Primary |
| Provider Name | Thomas F Kelly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760665889 PECOS PAC ID: 4284775883 Enrollment ID: I20111101000485 |
| Provider Name | Elizabeth Fisher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447763438 PECOS PAC ID: 1456615095 Enrollment ID: I20180507000733 |
| Provider Name | Denise C Tetzner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265813794 PECOS PAC ID: 9133556236 Enrollment ID: I20200303000084 |
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