Provider Demographics
NPI:1902033707
Name:DELCOLLO, JASON (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:DELCOLLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 EVERGREEN DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1059
Mailing Address - Country:US
Mailing Address - Phone:610-579-3444
Mailing Address - Fax:610-579-3449
Practice Address - Street 1:300 EVERGREEN DR
Practice Address - Street 2:SUITE 330
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1059
Practice Address - Country:US
Practice Address - Phone:610-579-3444
Practice Address - Fax:610-579-3449
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2022-03-17
Deactivation Date:2021-07-22
Deactivation Code:
Reactivation Date:2022-03-17
Provider Licenses
StateLicense IDTaxonomies
DEC20009997207Q00000X
PAOS015963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1902033707Medicaid