Provider Demographics
NPI:1629096771
Name:DELLON, ARNOLD LEE (MD)
Entity Type:Individual
Prefix:
First Name:ARNOLD
Middle Name:LEE
Last Name:DELLON
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 1:1122 KENILWORTH DR
Mailing Address - Street 2:SUITE 18
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2139
Mailing Address - Country:US
Mailing Address - Phone:410-337-5400
Mailing Address - Fax:410-337-0040
Practice Address - Street 1:1122 KENILWORTH DR
Practice Address - Street 2:SUITE 18
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2139
Practice Address - Country:US
Practice Address - Phone:410-337-5400
Practice Address - Fax:410-337-0040
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019722174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB70266Medicare UPIN
MD479M718FMedicare ID - Type UnspecifiedOPT OUT PROVIDER