Healthcare Provider Details

I. General information

NPI: 1932161700
Provider Name (Legal Business Name): CAROL DELFAUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 LIBBIE AVE SUITE 4
RICHMOND VA
23226-2659
US

IV. Provider business mailing address

2600 E KINGS RD
VIRGINIA BEACH VA
23452-7713
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-8082
  • Fax: 804-282-9082
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number0101041666
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: