Provider Demographics
NPI:1407898745
Name:DELMAR PEDIATRICS ,PLLC
Entity Type:Organization
Organization Name:DELMAR PEDIATRICS ,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-439-2273
Mailing Address - Street 1:1220 NEW SCOTLAND RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9208
Mailing Address - Country:US
Mailing Address - Phone:518-439-2273
Mailing Address - Fax:518-439-2834
Practice Address - Street 1:1220 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9208
Practice Address - Country:US
Practice Address - Phone:518-439-2273
Practice Address - Fax:518-439-2834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177933-12080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty