Provider Demographics
NPI:1700976198
Name:DALKILIC, ALICAN (MD)
Entity Type:Individual
Prefix:PROF
First Name:ALICAN
Middle Name:
Last Name:DALKILIC
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 1:1050 KINGS HWY N
Mailing Address - Street 2:STE 206
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1909
Mailing Address - Country:US
Mailing Address - Phone:856-208-7300
Mailing Address - Fax:
Practice Address - Street 1:15000 MIDLANTIC DR
Practice Address - Street 2:SUITE: 101
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1573
Practice Address - Country:US
Practice Address - Phone:856-380-2768
Practice Address - Fax:856-778-0636
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA076772002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009054M94 C03694Medicare ID - Type Unspecified
VAF71938Medicare UPIN