Provider Demographics
NPI:1104923002
Name:PILCHMAN, MARTHA DELGADILLO (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:DELGADILLO
Last Name:PILCHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:85 W MAIN ST
Mailing Address - Street 2:ST 101
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8345
Mailing Address - Country:US
Mailing Address - Phone:631-666-1400
Mailing Address - Fax:631-666-5781
Practice Address - Street 1:85 W MAIN ST
Practice Address - Street 2:ST 101
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8345
Practice Address - Country:US
Practice Address - Phone:631-666-1400
Practice Address - Fax:631-666-5781
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY154767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA62692Medicare UPIN
NY42D281Medicare ID - Type Unspecified