Provider Demographics
NPI:1568577229
Name:WAYNE A DELAMATER MD PA
Entity Type:Organization
Organization Name:WAYNE A DELAMATER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-624-0370
Mailing Address - Street 1:PO BOX 8190
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-8190
Mailing Address - Country:US
Mailing Address - Phone:575-624-0370
Mailing Address - Fax:575-624-0376
Practice Address - Street 1:1606 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-5404
Practice Address - Country:US
Practice Address - Phone:575-624-0370
Practice Address - Fax:575-624-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty