Basic Information
Provider Information
NPI: 1336138379
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DELZELL
FirstName: DAVID
MiddleName: W
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7757 AUBURN RD
Address2: UNIT 15
City: CONCORD TWP
State: OH
PostalCode: 440779609
CountryCode: US
TelephoneNumber: 3096925393
FaxNumber: 3096922583
Practice Location
Address1: 36000 EUCLID AVE
Address2:  
City: WILLOUGHBY
State: OH
PostalCode: 440944625
CountryCode: US
TelephoneNumber: 4403500832
FaxNumber: 4405790191
Other Information
ProviderEnumerationDate: 10/20/2005
LastUpdateDate: 03/31/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/31/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X35.068957OHY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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