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Content subject to change. Revised January 2017.
Medical License Direct
Solution for your medical license needs.
PHONE: 850-623-1302  ~ FAX: 904-339-9671
Medical License Direct, LLC ~ info@medicallicensedirect.com
Contact us Today
for
Free Pre-qualification
info@medicallicensedirect.com
Delaware Board of Medical Practice

861 Silver Lake Blvd., Cannon Bldg., Ste. 203
Dover, DE 19904
Telephone:  (302) 739-4522    Fax:  (302) 739-2711
Medical License Direct Makes Delaware Medical License
Application Process Easier for Physicians

Medical License Direct provides medical licensing services to physicians who are seeking state medical
licenses in one or more states.
Free up your time for other priorities by submitting either a paper or
online
form and your application will be completed generally within a couple days.

We have the Delaware Board of Medical Practice application on file in PDF format ready for professional
completion; a system that allows production of applications and third party verification forms almost
instantly while retaining personal information in a safe and confidential environment; and a state medical
board knowledge base that is extensive and updated frequently.

What our medical license service will do for you:
  • Provide FREE initial pre-qualification and medical licensing consultation
  • Research and prepare your Delaware medical application
  • Ship completed medical license application to you
  • Send all verification requests and follow up to make sure the right people receive and process them
    quickly
  • Provide continuous follow up and frequent board update reports until you're licensed.

That's it! Fast and easy.

Discounts are available for multi-state acquisitions.

Call,
850-471-8648, weekdays 9:00 am to 5:00 pm CST for a FREE initial consultation or quote.

Or email your questions to info@medicallicensedirect.com and you can generally expect a reply within a
few hours during business hours.

We also offer a
pre-qualification form for your convenience. Or, please click HERE for our paper or online
form and we'll get started right away.
Requirements for All Applicants

Your application packet must include all of the following:

Enclose the application instruction sheet with the applicable checklists completed.

Submit completed, signed and notarized Application for Physician License to Practice Medicine form.

Enclose the non-refundable processing fee by check or money order made payable to “State of Delaware.”

If you ever held a medical or training license in any jurisdiction other than Delaware, a license verification
from each jurisdiction where you have held a license is required. However, you will submit some verifications
in your application packet, while others will come directly from the jurisdiction to the Board office. Read the
following information about requesting verifications carefully:
If a jurisdiction utilizes VeriDoc to process license verifications, you must request the verification from
VeriDoc, not from the jurisdiction. VeriDoc will send the verification directly to the Board office, not to you. For
a list, click VeriDoc Participating States.
If you have ever held an Indiana license, request a digitally certified verification at http://www.in.gov/pla/verify.
htm. The site will download a verification in pdf format to your computer. Print the pdf document and send it in
your packet. Contrary to the instruction on Indiana’s site, please do not email the pdf document to the Board
office unless the Board office asks you to do so.
For all other jurisdictions, request the jurisdiction to send the verification to you and include it in your packet.
   You may use the Verification of Physician License form included with this application form to request the
verification.
   You may wish to obtain an AMA Profile or AOA Profile in order to make sure that you request verifications
of all licenses that you have ever held.
   Before requesting a verification, check whether the jurisdiction requires a fee.
   The jurisdiction’s seal must be affixed to the form.
   Remember to enclose the envelope in which you received the verification from the third party source.
Verifications that you print off the internet or receive by fax will not be accepted.

Unless an exception listed below applies, obtain a Service Letter from each healthcare facility where you
currently have, or had within the past three years, either direct patient access or admitting or staff privileges.
A responsible physician at the facility must sign the form.
Remember to enclose the envelopes in which you received each Service Letter.
You do not have to provide a Service Letter for the following practice situations:
   You were practicing as an intern, resident, fellow, or house physician for the past three years.
   Your practice for the past three years was via telemedicine with no direct patient access.
   You were a locum tenens with no direct patient access for the past three years.

If you are currently in training, submit a signed letter from the program director of your training institution on
the institution’s letterhead.  It must state that you have successfully completed your first year of training and
the anticipated date you will complete your training.  

If any of the following describes your situation, obtain two letters of reference from physicians who are
familiar with you but are not related to you:
You have practiced only as an intern, resident, fellow or house physician, or
You were self-employed for the entire past three years, or
You had no direct patient access during the past three years, or
One or more of the facilities where you had direct patient access in the past three years no longer exists.

If you answer “yes” to questions in the DISCLOSURES section - other then Questions 32, 34, 35 - you must
fully explain your answer. We suggest that you use the Physician Self-Report form for this purpose. However,
if the Physician Self-Report does not fully cover your situation, submit a signed, notarized statement in lieu of
or in addition the Physician Self-Report.

Request a self-query from the National Practitioner and Healthcare Integrity and Protection Data Banks
(NPDB/HIPDB) website at www.npdb-hipdb.hrsa.gov. The self-query report will be mailed to your address.
When you receive the report, enclose the original report in your application packet.

If you have never been issued a U.S. Social Security Number (SSN), submit a Request for Exemption from
Social Security Number Requirement.

In addition, arrange for the Board office to receive the following documents directly from the third party
sources.

Complete the Criminal History Record Check Authorization form to request State of Delaware and Federal
Bureau of Investigation criminal background checks. Follow the instructions on the authorization form to
arrange to be fingerprinted. The State Bureau of Identification will send the report directly to the Board office.

Complete, sign and submit the Delaware Child Protection Registry Request Form to the Department of
Services for Children, Youth & Their Families following the instructions on the form. DSCYF will send the
report directly to the Board office.

If a jurisdiction where you have ever held a medical or training license utilizes VeriDoc to process their
license verifications, request the verification from VeriDoc, not from the jurisdiction. VeriDoc will send the
verification directly to the Board office. For a list, click VeriDoc Participating States.

Additional Requirement for FCVS Applicants

Delaware accepts the Federation Credentials Verification Service (FCVS) of the Federation of State Medical
Boards (FSMB). If you are using the FCVS service, the following requirement applies in addition to the items
listed in Requirements for All Applications above:

Request your Physician Information Profile from FCVS at www.fsmb.org/fcvs_physapp.html. FCVS will send
the profile directly to the Board office.

Additional Requirements for Non-FCVS Applicants

If you are not using the FCVS service, the application packet that you submit must include all of the following
in addition to the items listed in Requirements for All Applications above:

Submit an 8 1/2" X 11" copy of your medical school diploma. If you are a foreign medical graduate, attach an
English translation from a reputable translating organization.

Obtain a Verification of Medical Education from each medical school you attended.
The school’s seal must be affixed to the form. If no seal is available, the form must be notarized.
Internet verifications or faxed verifications will not be accepted.

If you graduated from a foreign medical school, submit 8 1/2" X 11" copy of your current and valid
Educational Commission for Foreign Medical Graduates (ECFMG) certificate.

Submit an 8 1/2" X 11" copy of your Postgraduate Education Training Certificate(s).
Only training programs are those that have been approved by the Accreditation Council for Graduate
Medical Education will be accepted.
If you graduated from a program approved by the American Medical Association (AMA) or American
Osteopathic Association (AOA) in the U.S. (or U.S. territory) or Canada, you must have completed one year
of postgraduate training in the U.S.
If you did not graduate from an AMA- or AOA-approved program, you must have completed three years of
postgraduate training in the U.S.

Obtain a Verification of Post Graduate Medical Education form from each program that you attended.
The program’s seal must be affixed to the form. If no seal is available, the form must be notarized.
Internet verifications or faxed verifications will not be accepted.

Obtain a complete examination history, including all passing and failing attempts, from the following
organizations:
ECFMG – Request report at www.ecfmg.org.
Federal Licensing Examination (FLEX), United States Medical Licensing Examination (USMLE), and Special
Purpose Examination (SPEX) examinations administered by the Federation of State Medical Boards –
Request report at www.fsmb.org.
National Board of Medical Examiners (NBME) examination administered by the National Board of Medical
Examiners – Request report at www.nbme.org.
National Board of Osteopathic Medical Examiners (NBOME) Comprehensive Osteopathic Medical Licensing
Examination (COMLEX-USA) examinations administered by the National Board of Osteopathic Medical
Examiners. Request report at www.nbome.org
Qualifying Examination (QE) Part I and Part II conducted by the Medical Council of Canada for the purpose of
awarding the "Licentiate of the Medical Council of Canada" (LMCC). Request report at www.mcc.ca.

Controlled Substance Registration

The application for Physician licensure is NOT an application for a controlled substance registration (CSR).
For the CSR application and instructions, see Application for Controlled Substances Registration –
Practitioners.

If you apply for your Physician license and CSR at the same time, the Controlled Substance application will
be processed after your Physician license is issued. When your Delaware CSR is approved, you must then
file for a federal DEA registration.