Provider Demographics
NPI:1972573947
Name:DELAGO, CYNTHIA W (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:W
Last Name:DELAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5501 OLD YORK RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-7170
Mailing Address - Fax:215-456-3434
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-7171
Practice Address - Fax:215-456-3436
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05268400208000000X
NJ25MA052684002080C0008X
PAMD039793E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6216404Medicaid
NJF92302Medicare UPIN