Provider Demographics
NPI:1619418233
Name:DELGIACCO MEDICAL
Entity Type:Organization
Organization Name:DELGIACCO MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGIACCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:585-259-3040
Mailing Address - Street 1:6048 ESTATE CASTLE COAKLEY
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820
Mailing Address - Country:US
Mailing Address - Phone:340-772-1551
Mailing Address - Fax:340-772-1555
Practice Address - Street 1:6048 ESTATE CASTLE COAKLEY
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-772-1551
Practice Address - Fax:340-772-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2121207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIIH635AMedicare UPIN