Provider Demographics
NPI:1932212776
Name:DELVECCHIO, PASQUALE A (MD)
Entity Type:Individual
Prefix:
First Name:PASQUALE
Middle Name:A
Last Name:DELVECCHIO
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 1:200 BEACON PKWY W
Mailing Address - Street 2:SUITE330
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3102
Mailing Address - Country:US
Mailing Address - Phone:205-715-5910
Mailing Address - Fax:205-715-5928
Practice Address - Street 1:2800 ALLISON BONNETT MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-1845
Practice Address - Country:US
Practice Address - Phone:205-744-4410
Practice Address - Fax:205-744-6150
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000001704Medicaid
AL1704Medicare ID - Type Unspecified
AL000001704Medicaid