Provider Demographics
NPI:1245221159
Name:DELCAMBRE, MARIE A (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:DELCAMBRE
Suffix:
Gender:F
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:PO BOX 22236
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915
Mailing Address - Country:US
Mailing Address - Phone:913-451-8500
Mailing Address - Fax:
Practice Address - Street 1:12140 NALL AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209
Practice Address - Country:US
Practice Address - Phone:913-451-8500
Practice Address - Fax:913-498-1551
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3E02207R00000X
KS04-20883207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202518627Medicaid
KS200307380Medicaid
MOB96929Medicare UPIN
MO202518627Medicaid