Provider Demographics
NPI:1457319618
Name:DELBALSO, ANGELO M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:M
Last Name:DELBALSO
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 1:30 BOUNDBROOK CT
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1653
Mailing Address - Country:US
Mailing Address - Phone:716-689-0428
Mailing Address - Fax:
Practice Address - Street 1:3495 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:716-834-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1396382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00025344603OtherUNIVERA
1608497OtherINDEPENDENT HEALTH
4195935OtherGHI
040426000279OtherFIDELIS
197582FFOtherPREFERRED CARE
P00028814OtherRR MEDICARE
000510133012OtherBLUE SHIELD WNY
NY01144090Medicaid
NY1396381WOtherNYS WORKERS COMPENSATION
NY01144090Medicaid
NY1396381WOtherNYS WORKERS COMPENSATION