| Organization Name: | FENWICK MEDICAL CENTER PA |
| NPI Number: | 1396780664 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NICHOLAS N. BORODULIA (DOCTOR/EMPLOYER) |
| Mailing Address: | 12036 S Piney Point Rd Bishopville |
| State: | MD US |
| Postal Code: | 218131542 |
| Phone Number: | 4104305154 |
| Fax Number: | 4103525430 |
| NPI Enumeration Date: | 06/19/2006 |
| NPI Last Update Date: | 04/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | C10001802 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | DE |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |