Healthcare Provider Details

I. General information

NPI: 1952391377
Provider Name (Legal Business Name): MARY-ELIZABETH DELMONTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 PORTER ST BARQUIST ARMY HEALTH CLINIC
FORT DETRICK MD
21702-9254
US

IV. Provider business mailing address

16844 FALCONHURST DR
PURCELLVILLE VA
20132-9647
US

V. Phone/Fax

Practice location:
  • Phone: 301-619-2217
  • Fax:
Mailing address:
  • Phone: 540-338-5590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9300680
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: