Healthcare Provider Details

I. General information

NPI: 1396701876
Provider Name (Legal Business Name): DELTA MEDIX PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LACKAWANNA AVE
SCRANTON PA
18503-2001
US

IV. Provider business mailing address

300 LACKAWANNA AVE
SCRANTON PA
18503-2001
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-7864
  • Fax: 570-207-7678
Mailing address:
  • Phone: 570-558-3565
  • Fax: 570-207-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000715941
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MRS. THERESA DEMYAN
Title or Position: ACCOUNTANT
Credential: CPA
Phone: 570-558-3565