Provider Demographics
NPI:1578525929
Name:VIRTUE-DELAYO, LAURA (DPM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VIRTUE-DELAYO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2918
Mailing Address - Country:US
Mailing Address - Phone:570-558-8660
Mailing Address - Fax:570-558-6147
Practice Address - Street 1:1032 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-2918
Practice Address - Country:US
Practice Address - Phone:570-558-8660
Practice Address - Fax:570-558-6147
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004844L213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100962275Medicaid
PAU99135Medicare UPIN
PA077433Medicare PIN