Provider Demographics
NPI:1942265889
Name:DELACEY, WILLIAM AGUSTINE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:AGUSTINE
Last Name:DELACEY
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 1:2000 MEADE PKWY
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4259
Mailing Address - Country:US
Mailing Address - Phone:757-925-0759
Mailing Address - Fax:757-510-9436
Practice Address - Street 1:2000 MEADE PKWY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4259
Practice Address - Country:US
Practice Address - Phone:757-925-0759
Practice Address - Fax:757-510-9436
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047940207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6009590Medicaid
NC7906603Medicaid
VA060024220OtherRAILROAD MEDICARE
VA6009590Medicaid
NC7906603Medicaid