Provider Demographics
NPI:1427093079
Name:DELGAUDIO, LORI E (DO)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:E
Last Name:DELGAUDIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 N RIVER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2600
Mailing Address - Country:US
Mailing Address - Phone:570-288-6616
Mailing Address - Fax:570-288-6860
Practice Address - Street 1:545 N RIVER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2600
Practice Address - Country:US
Practice Address - Phone:570-288-6616
Practice Address - Fax:570-288-6860
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010857L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018121440006Medicaid
PA123397Medicare ID - Type Unspecified
PA0018121440006Medicaid