Provider Demographics
NPI:1619092541
Name:DELISE, CLAUDIO M (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDIO
Middle Name:M
Last Name:DELISE
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 1:20 NORTHWOOD DR
Mailing Address - Street 2:#301
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1153
Mailing Address - Country:US
Mailing Address - Phone:781-337-1345
Mailing Address - Fax:
Practice Address - Street 1:851 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1613
Practice Address - Country:US
Practice Address - Phone:781-337-1345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44371207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology