MEDICARE: JOHN DAVID DELAPA ARDMS, AART

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	247100000X	Radiologic Technologist	38261	OH

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548365695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DAVID DELAPA ARDMS, AART

Provider Business Mailing Address
First Line	:	189 COUNTY ROAD 276
Second Line	:
City	:	SOUTH POINT
State	:	OH
Zip	:	45680-8912
Country	:	US
Telephone Number	:	740-894-7155
Fax Number	:	740-894-3390

Provider Business Practice Location Address
First Line	:	189 COUNTY ROAD 276
Second Line	:
City	:	SOUTH POINT
State	:	OH
Zip	:	45680-8912
Country	:	US
Telephone Number	:	740-894-7155
Fax Number	:	740-894-3390

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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