Organization
SPORTS MEDICINE OF DELAWARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINCENT NEIL DISABELLA DO (PRESIDENT)
(302) 376-9711
Entity
Organization
Contact information
Practice address
102 SLEEPY HOLLOW DR, SUITE 102, MIDDLETOWN, DE 19709-8894
(302) 376-9711
(302) 376-9713
Mailing address
102 SLEEPY HOLLOW DR, SUITE 102, MIDDLETOWN, DE 19709-5841
(302) 376-9711
(302) 376-9713
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
C2-0005338
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100040718
—
DE
01
—
2803109000
AMERIHEALTH
DE
Enumeration date
06/01/2006
Last updated
11/04/2008
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