Provider Demographics
NPI:1457423147
Name:DELLAMAGGIORE, EUGENE D (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:D
Last Name:DELLAMAGGIORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 OCONNOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1623
Mailing Address - Country:US
Mailing Address - Phone:408-297-3484
Mailing Address - Fax:408-292-6481
Practice Address - Street 1:333 OCONNOR DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1623
Practice Address - Country:US
Practice Address - Phone:408-297-3484
Practice Address - Fax:408-292-6481
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77645207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G776450Medicare ID - Type Unspecified
CAH59993Medicare UPIN