Provider Demographics
NPI:1750541629
Name:JOHN R. DELANEY MD PA
Entity type:Organization
Organization Name:JOHN R. DELANEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-344-1476
Mailing Address - Street 1:1849 BRIGHTWATERS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3005
Mailing Address - Country:US
Mailing Address - Phone:727-344-1476
Mailing Address - Fax:727-344-1477
Practice Address - Street 1:1135 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-2887
Practice Address - Country:US
Practice Address - Phone:727-344-1476
Practice Address - Fax:727-344-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00178262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038575100Medicaid
FL52797Medicare PIN
FL038575100Medicaid