Provider Demographics
NPI:1255101119
Name:MCCALL, DELTON SR
Entity type:Individual
Prefix:
First Name:DELTON
Middle Name:
Last Name:MCCALL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 E CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-5873
Mailing Address - Country:US
Mailing Address - Phone:724-397-7141
Mailing Address - Fax:
Practice Address - Street 1:458 E CHURCH LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-5873
Practice Address - Country:US
Practice Address - Phone:484-683-5023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA25270123343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)