Provider Demographics
NPI:1053863449
Name:DALCHERONE, DESIREE (DPM)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:DALCHERONE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-3111
Mailing Address - Country:US
Mailing Address - Phone:229-405-6959
Mailing Address - Fax:
Practice Address - Street 1:401 S MADISON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-3111
Practice Address - Country:US
Practice Address - Phone:229-405-6959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001464213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist