Provider Demographics
NPI:1346304490
Name:DELGADO, FERNANDO ALFONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:ALFONSO
Last Name:DELGADO
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:PO BOX 42215
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21284-2215
Mailing Address - Country:US
Mailing Address - Phone:202-689-5548
Mailing Address - Fax:
Practice Address - Street 1:41 LOCUST PATH CT
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5548
Practice Address - Country:US
Practice Address - Phone:202-689-5548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD517P006HMedicare PIN
MD429951500Medicaid