Provider Demographics
NPI:1063728483
Name:DELIMATA, MEGAN (MD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:DELIMATA
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 1:100 N DEAN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3710
Mailing Address - Country:US
Mailing Address - Phone:407-384-7388
Mailing Address - Fax:407-384-7391
Practice Address - Street 1:100 NORTH DEAN ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4970
Practice Address - Country:US
Practice Address - Phone:407-384-7388
Practice Address - Fax:407-384-7391
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120725207RG0100X
FLME109060207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005913500Medicaid
211316001Medicare PIN
FL005913500Medicaid