Provider Demographics
NPI:1104823210
Name:DELAMATER, PAUL V (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:V
Last Name:DELAMATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W CENTRAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3834
Mailing Address - Country:US
Mailing Address - Phone:419-537-5111
Mailing Address - Fax:419-537-5131
Practice Address - Street 1:2100 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3834
Practice Address - Country:US
Practice Address - Phone:419-537-5111
Practice Address - Fax:419-537-5131
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350317652080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0252926Medicaid
OH4044692OtherAETNA
OHDE4204432Medicare PIN
OH0252926Medicaid