Basic Information
| Provider Information | |||||||||
| NPI: | 1609872027 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELCAMP | ||||||||
| FirstName: | DON | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 S STANFIELD RD | ||||||||
| Address2: | STE 202 | ||||||||
| City: | TROY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453732374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373353561 | ||||||||
| FaxNumber: | 9373391213 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 S STANFIELD RD | ||||||||
| Address2: | STE 202 | ||||||||
| City: | TROY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453732374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373353561 | ||||||||
| FaxNumber: | 9373391213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 08/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 35049812D | OH | N | Other Service Providers | Specialist | 207X00000X | 35049812 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0536174 | 05 | OH | MEDICAID | AD2460652 | 01 | OH | DEA | OTHER | 35049812 | 01 | OH | STATE LICENSE | OTHER |