Provider Demographics
NPI:1184605313
Name:DELGALVIS, SUSAN C (MD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:C
Last Name:DELGALVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3851 PIPER ST
Mailing Address - Street 2:U340
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:970-244-7050
Mailing Address - Fax:970-255-1724
Practice Address - Street 1:3851 PIPER ST
Practice Address - Street 2:U340
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-562-0321
Practice Address - Fax:907-562-2683
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37353207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45921245Medicaid
B36295Medicare UPIN
COC502998Medicare PIN