MEDICARE: LAURA VIRTUE-DELAYO DPM

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	213E00000X	Podiatrist	SC004844L	PA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	SC004844L	PA
3	213ES0131X	Foot Surgery Podiatrist	SC004844L	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

General Provider Information

NPI Number	:	1578525929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA VIRTUE-DELAYO DPM

Provider Business Mailing Address
First Line	:	1032 N WASHINGTON AVE
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18509-2918
Country	:	US
Telephone Number	:	570-558-8660
Fax Number	:	570-558-6147

Provider Business Practice Location Address
First Line	:	1032 N WASHINGTON AVE
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18509-2918
Country	:	US
Telephone Number	:	570-558-8660
Fax Number	:	570-558-6147

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	07/28/2021

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Directions to “ LAURA VIRTUE-DELAYO DPM” Practice Location

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