Provider Demographics
NPI:1417908807
Name:DELISLE, SYLVAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLVAIN
Middle Name:
Last Name:DELISLE
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 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-705-7197
Mailing Address - Fax:410-328-0177
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-705-7197
Practice Address - Fax:410-328-0177
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD51204207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1417908807Medicaid
MD544477-04OtherBLUE CROSS/BLUE SHIELD
WV2003782000Medicaid
VA5852145Medicaid
MD867000500Medicaid
MD314SMedicare PIN
MDE23513Medicare UPIN
VA5852145Medicaid