MEDICARE: DR. ERIC J DELAURA 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	2085R0202X	Diagnostic Radiology Physician	232519	NY
2	2085R0204X	Vascular & Interventional Radiology Physician	25MB07747200	NJ

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	:	1720009574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC J DELAURA D.O.

Provider Business Mailing Address
First Line	:	40 VALLEY STREAM PKWY STE 100
Second Line	:	ATTN: CREDENTIALING DEPT.
City	:	MALVERN
State	:	PA
Zip	:	19355-1407
Country	:	US
Telephone Number	:	610-644-8900
Fax Number	:	610-644-8909

Provider Business Practice Location Address
First Line	:	1050 GALLOPING HILL RD STE 102
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-7980
Country	:	US
Telephone Number	:	908-686-1350
Fax Number	:	908-686-1382

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/18/2023

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