MEDICARE: JACLYN DELGRECO D.O.

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	OT013545	PA
2	207Q00000X	Family Medicine Physician	OS016147	PA

General Provider Information

NPI Number	:	1669793907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN DELGRECO D.O.

Provider Business Mailing Address
First Line	:	2175 MCCLELLANDTOWN RD
Second Line	:
City	:	MASONTOWN
State	:	PA
Zip	:	15461-2593
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2175 MCCLELLANDTOWN RD
Second Line	:
City	:	MASONTOWN
State	:	PA
Zip	:	15461-2593
Country	:	US
Telephone Number	:	724-583-2819
Fax Number	:

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

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	06/18/2013

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