Provider Demographics
NPI:1194845388
Name:DELADISMA, ADELINE MAE (MD)
Entity type:Individual
Prefix:
First Name:ADELINE
Middle Name:MAE
Last Name:DELADISMA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-281-9065
Mailing Address - Fax:
Practice Address - Street 1:400 PINELLAS ST STE 200
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3312
Practice Address - Country:US
Practice Address - Phone:727-462-2131
Practice Address - Fax:727-266-4914
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD72711208600000X
IN01071770A208600000X
GA00498208600000X
FLME134033208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD97509402OtherBCBS
DCV8080011OtherBCBS
DCV8380011OtherBCBS
DCV8740011OtherBCBS
MD045199100Medicaid
MD97509401OtherBCBS
MD97509403OtherBCBS
DCV8380011OtherBCBS
MD225800Y5ZMedicare PIN
DCV8740011OtherBCBS