Provider Demographics
NPI:1184692006
Name:DELEON, MARY JEANNE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JEANNE
Last Name:DELEON
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 1:820 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2028
Mailing Address - Country:US
Mailing Address - Phone:509-663-8711
Mailing Address - Fax:
Practice Address - Street 1:820 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2028
Practice Address - Country:US
Practice Address - Phone:509-663-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60784399207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8971577OtherWVH PTAN
WA1184692006Medicaid
WAG8971576OtherWVH PTAN
I05746Medicare UPIN
WAG8971576OtherWVH PTAN
WAG8971577OtherWVH PTAN
PA1613781OtherHIGHMARK BLUE SHIELD
PA50054312OtherCAPITAL BLUE CROSS
PA7719541OtherAETNA
PA2510669OtherUNITEDHEALTHCARE