Healthcare Provider Details

I. General information

NPI: 1972573947
Provider Name (Legal Business Name): CYNTHIA W. DELAGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD 1ST FLOOR
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

5501 OLD YORK RD 1ST FLOOR
PHILADELPHIA PA
19141-3018
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7171
  • Fax: 215-456-3436
Mailing address:
  • Phone: 215-456-7170
  • Fax: 215-456-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA05268400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number25MA05268400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD039793E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: