Provider Demographics
NPI:1851489405
Name:WARDLAW, DELANA (MD)
Entity Type:Individual
Prefix:DR
First Name:DELANA
Middle Name:
Last Name:WARDLAW
Suffix:
Gender:F
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:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-324-0500
Mailing Address - Fax:215-324-3767
Practice Address - Street 1:4350 GERMANTOWN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-1749
Practice Address - Country:US
Practice Address - Phone:215-324-0500
Practice Address - Fax:215-324-3767
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3009814OtherKMHP
PA10713OtherELDERHEATH
PA1607749OtherBLUE SHIELD
PA2696372OtherCIGNA
PA7477510OtherAETNA
PA01960067Medicaid
PA0196006702OtherAMERICHOICE
PA2285593000OtherKHPE
PACD4829OtherRAILROAD MEDICARE
PA597586OtherMEDICARE GROUP
PA1607749OtherPC
PA0196006702OtherAMERICHOICE
PA1607749OtherBLUE SHIELD