Provider Demographics
NPI:1780601468
Name:DEPAOLA, DELIA (MD)
Entity type:Individual
Prefix:DR
First Name:DELIA
Middle Name:
Last Name:DEPAOLA
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 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:1221 MERCANTILE LN
Practice Address - Street 2:KAISER PERMANENTE LARGO MEDICAL CENTER
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5374
Practice Address - Country:US
Practice Address - Phone:301-618-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00450852085R0202X
VA01010432372085R0202X
DCMD0393732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD60234801OtherBLUE SHIELD
DC80430036OtherBLUE SHIELD
MD143431400Medicaid
DC013319YXFMedicare PIN
MD143431400Medicaid
DC013319D05Medicare PIN
DC80430036OtherBLUE SHIELD
MD60234801OtherBLUE SHIELD