Provider Demographics
NPI:1609850965
Name:SIMON, DELLA JAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DELLA
Middle Name:JAYNE
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 FAR HORIZONS LN
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2046
Mailing Address - Country:US
Mailing Address - Phone:828-771-2219
Mailing Address - Fax:828-771-2634
Practice Address - Street 1:100 FAR HORIZONS LN
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2046
Practice Address - Country:US
Practice Address - Phone:828-771-2219
Practice Address - Fax:828-771-2634
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1609850965Medicaid
NC129VWOtherBCBS
NCNCN797AMedicare PIN
NC1609850965Medicaid