Provider Demographics
NPI:1295017093
Name:DELISLE, ANNIE JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:JOAN
Last Name:DELISLE
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 1:2344 6TH STREET
Mailing Address - Street 2:ATTENTION: CREDENTIALING DEPT.
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710
Mailing Address - Country:US
Mailing Address - Phone:510-981-4100
Mailing Address - Fax:510-553-2169
Practice Address - Street 1:2001 DWIGHT WAY
Practice Address - Street 2:INSIDE ALTA BATES / HERRICK
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2608
Practice Address - Country:US
Practice Address - Phone:510-981-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine