Provider Demographics
NPI:1629070404
Name:DELEO, JOANNA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:MARIE
Last Name:DELEO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 JONESTOWN RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-1745
Mailing Address - Country:US
Mailing Address - Phone:717-652-5552
Mailing Address - Fax:717-671-1870
Practice Address - Street 1:4811 JONESTOWN RD
Practice Address - Street 2:SUITE 126
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-1745
Practice Address - Country:US
Practice Address - Phone:717-652-5552
Practice Address - Fax:717-671-1870
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007425L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7601109OtherGATEWAY ID
PA02802100OtherCAPITAL BLUE CROSS
PA0015286490003Medicaid
PA511640OtherUS HEALTHCARE ID
PA7601109OtherGATEWAY ID
PA601109XPJMedicare PIN