Provider Demographics
NPI:1174521447
Name:DELGADO, MARTA I (MD)
Entity type:Individual
Prefix:DR
First Name:MARTA
Middle Name:I
Last Name:DELGADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 NE 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030
Mailing Address - Country:US
Mailing Address - Phone:786-243-1909
Mailing Address - Fax:786-243-4292
Practice Address - Street 1:43 NE 15TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030
Practice Address - Country:US
Practice Address - Phone:786-243-1909
Practice Address - Fax:786-243-4292
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86719208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268437301Medicaid
FL5598641OtherFIRST HEALTH ID#
FL157747195334OtherHUMANA PROVIDER ID#
FL285747OtherAMERIGROUP
FL7988633OtherAETNA PROVIDER ID#
FL268437300Medicaid
FL274606OtherWELLCARE
FL64062OtherBCB PROVIDER ID#
FL296148OtherAVMED