Healthcare Provider Details

I. General information

NPI: 1730270968
Provider Name (Legal Business Name): WALTER R DELGAUDIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 S RIVER ST STE 301
PLAINS PA
18705-1032
US

IV. Provider business mailing address

670 S RIVER ST STE 301
PLAINS PA
18705-1032
US

V. Phone/Fax

Practice location:
  • Phone: 570-270-2600
  • Fax: 570-270-2828
Mailing address:
  • Phone: 570-270-2600
  • Fax: 570-270-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD418280E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: