Provider Demographics
NPI:1467414466
Name:DELGADO, RICARDO J (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:J
Last Name:DELGADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:G
Other - Last Name:DELGADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1686
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1686
Mailing Address - Country:US
Mailing Address - Phone:317-614-9863
Mailing Address - Fax:706-232-0156
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:678-442-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA36956207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00698156AMedicaid
GA00698156AMedicaid
G23250Medicare UPIN
GA220017023Medicare PIN