Provider Demographics
NPI:1982658571
Name:DIGREGORIO, DELIA M (MD)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:M
Last Name:DIGREGORIO
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 1:460 DARBYS RUN
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2969
Mailing Address - Country:US
Mailing Address - Phone:440-333-5983
Mailing Address - Fax:
Practice Address - Street 1:1012 E PERKINS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5070
Practice Address - Country:US
Practice Address - Phone:419-625-4995
Practice Address - Fax:419-625-2720
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-034833208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0206173Medicaid
OHIN-PROCESSMedicare ID - Type UnspecifiedCREDENTIALING PENDING
CF06556Medicare UPIN