Provider Demographics
NPI:1487316881
Name:DELGADO, MIGUEL A
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:DELGADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 LEE JACKSON CT APT 7
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-9465
Mailing Address - Country:US
Mailing Address - Phone:540-335-9491
Mailing Address - Fax:
Practice Address - Street 1:186 LEE JACKSON CT APT 7
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815-9465
Practice Address - Country:US
Practice Address - Phone:540-335-9491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty