Shore Internal Medicine Associates

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C10005048 Issued in DE

Legal business name

SHORE INTERNAL MEDICINE ASSOCIATES

Practice address

1302 Savannah Rd
Lewes, DE 19958-1526

Phone

(302) 645-6644

Fax

(302) 645-6790

NPI assigned

Jun 6, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin P Wallace, M.D

Title

Owner

Phone

(302) 645-6644

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083653976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 SAVANNAH RD",
            "city": "LEWES",
            "state": "DE",
            "postal_code": "199581526",
            "telephone_number": "302-645-6644",
            "fax_number": "302-645-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 SAVANNAH RD",
            "city": "LEWES",
            "state": "DE",
            "postal_code": "199581526",
            "telephone_number": "302-645-6644",
            "fax_number": "302-645-6790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE INTERNAL MEDICINE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "302-645-6644",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "DE",
            "license": "C10005048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarian Sheriff
• Mary Eleanor Sherwood, MS, CDMS, CCM
• Amber Shetzler
• Stacy Joan Shirk, RN
• Kathy Shook, RN
• Shore Movement Physical Therapy, P.a.
• Shore Rheumatology Inc
• Julie Short, RN
• Kathleen Richadson Short, BSN
• Rowan Short, RN

• Internal Medicine Physician in Lewes, DE
• Providers in Lewes, DE by specialty
• Internal Medicine Physician in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.