Provider Demographics
NPI:1285924415
Name:JOSE PICAZO MD PA
Entity type:Organization
Organization Name:JOSE PICAZO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PICAZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-738-6535
Mailing Address - Street 1:600 CHRISTIANA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1656
Mailing Address - Country:US
Mailing Address - Phone:302-738-6535
Mailing Address - Fax:302-738-6517
Practice Address - Street 1:600 CHRISTIANA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1656
Practice Address - Country:US
Practice Address - Phone:302-738-6535
Practice Address - Fax:302-738-6517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0005063207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000807001Medicaid
DE0000807001Medicaid