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General NPI Number Information
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NPI Number | 1013185842
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Entity Type | Individual
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Provider Name | GREGORY DALENCOURT M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 110 HOSPITAL RD STE 101
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-4019
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Country | US
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Telephone | 410-535-8195
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Fax |
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Provider Business Mailing Address
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Address Line | 110 HOSPITAL RD STE 101
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-4019
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Country | US
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Telephone | 347-712-0528
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 247251
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036141318
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D0099371
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License Number State | MD
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