Provider Demographics
NPI:1316908866
Name:DELPORT, ELVA GRACE (MKD)
Entity type:Individual
Prefix:
First Name:ELVA
Middle Name:GRACE
Last Name:DELPORT
Suffix:
Gender:F
Credentials:MKD
Other - Prefix:
Other - First Name:ELVA
Other - Middle Name:GRACE
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4735 OGLETOWN-STANTON RD
Mailing Address - Street 2:SUITE 2210
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-623-4144
Mailing Address - Fax:302-623-4147
Practice Address - Street 1:4735 OGLETOWN-STANTON RD
Practice Address - Street 2:SUITE 2210
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-623-4144
Practice Address - Fax:302-623-4147
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005721208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE510110596OtherBCBS OF DE
DE2207837OtherAETNA
DE0296025000OtherAMERIHEALTH
DE9132OtherCOVENTRY
DE2114925OtherUNITED HEALTH CARE
DE2114925OtherUNITED HEALTH CARE
DE0296025000OtherAMERIHEALTH