Provider Demographics
NPI:1821268079
Name:SELMA C DELIMA MD PA
Entity Type:Organization
Organization Name:SELMA C DELIMA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SELMA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DELIMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:386-738-9144
Mailing Address - Street 1:923 N SPRING GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2560
Mailing Address - Country:US
Mailing Address - Phone:386-738-9144
Mailing Address - Fax:386-738-9213
Practice Address - Street 1:923 N SPRING GARDEN AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2560
Practice Address - Country:US
Practice Address - Phone:386-738-9144
Practice Address - Fax:386-738-9213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259501000Medicaid
FL259501000Medicaid
FL35933Medicare PIN