MEDICARE: DR. CYNTHIA W. DELAGO M.D.

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	208000000X	Pediatrics Physician	MA05268400	NJ
2	2080C0008X	Child Abuse Pediatrics Physician	25MA05268400	NJ
3	208000000X	Pediatrics Physician	MD039793E	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	:	1972573947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA W. DELAGO M.D.

Provider Business Mailing Address
First Line	:	5501 OLD YORK RD
Second Line	:	1ST FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-3018
Country	:	US
Telephone Number	:	215-456-7170
Fax Number	:	215-456-3434

Provider Business Practice Location Address
First Line	:	5501 OLD YORK RD
Second Line	:	1ST FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-3018
Country	:	US
Telephone Number	:	215-456-7171
Fax Number	:	215-456-3436

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	11/04/2014

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