MEDICARE: DR. DELIA CHRISTINA MELTONTATE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD043306L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1490297	OTHER	PA	HIGHMARK BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	002769	OTHER	PA	FIRST PRIORITY HEALTH
5	96030-C241	OTHER	PA	GEISINGER
6	232175463	OTHER	PA	AETNA
7	232175463	OTHER	PA	AMERIHEALTH

General Provider Information

NPI Number	:	1114907334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DELIA CHRISTINA MELTONTATE MD

Provider Business Mailing Address
First Line	:	5619-25 VINE STREET
Second Line	:	SPECTRUM HEALTH SERVICES, INC.
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-1302
Country	:	US
Telephone Number	:	215-471-2761
Fax Number	:	215-471-2929

Provider Business Practice Location Address
First Line	:	1415 NORTH BROAD STREET, SUITE 224
Second Line	:	BROAD STREET HEALTH CENTER
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-3323
Country	:	US
Telephone Number	:	215-235-7944
Fax Number	:	215-235-3361

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	01/20/2011

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