Provider Demographics
NPI:1386632271
Name:DIZON, MARIA ANGELA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ANGELA
Last Name:DIZON
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 1:701 N CLAYTON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3165
Mailing Address - Country:US
Mailing Address - Phone:302-578-8103
Mailing Address - Fax:302-578-8144
Practice Address - Street 1:701 N CLAYTON ST STE 301
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3165
Practice Address - Country:US
Practice Address - Phone:302-578-8103
Practice Address - Fax:302-578-8144
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20255207ZP0102X
PAMD060183L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA710893OtherHIGHMARK
WV1801756000Medicaid
OH2316685Medicaid
PA710893OtherHIGHMARK
WV4073121Medicare ID - Type Unspecified
G47072Medicare UPIN