Provider Demographics
NPI:1720315682
Name:DAGLI, DELIA (PA)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:
Last Name:DAGLI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DELIA
Other - Middle Name:
Other - Last Name:HAMIDZADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:100 MLK JR BLVD #110
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1209
Mailing Address - Country:US
Mailing Address - Phone:508-754-3823
Mailing Address - Fax:508-753-0151
Practice Address - Street 1:100 MLK JR BLVD #110
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1209
Practice Address - Country:US
Practice Address - Phone:508-754-3823
Practice Address - Fax:508-753-0151
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA3906363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant