Healthcare Provider Details

I. General information

NPI: 1669793907
Provider Name (Legal Business Name): JACLYN DELGRECO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 MCCLELLANDTOWN RD
MASONTOWN PA
15461-2593
US

IV. Provider business mailing address

2175 MCCLELLANDTOWN RD
MASONTOWN PA
15461-2593
US

V. Phone/Fax

Practice location:
  • Phone: 724-583-2819
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT013545
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS016147
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: