Individual
MARY MAITLAND DELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1507 ALICE DR, LAFAYETTE, LA 70503-5083
(337) 989-0812
(337) 284-3799
Mailing address
1507 ALICE DR, LAFAYETTE, LA 70503-5083
(337) 989-0812
(337) 284-3799
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
05746R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1319236
—
LA
01
—
5DX68
ONCOLOGICS LLC GROUP PTAN EFFECTIVE 05/19/2012
LA
01
—
5L616DX68
M. MAITLAND DELAND MEDICARE PTAN EFFECTIVE 05/19/2012
LA
01
—
P00475837
MEDICARE RR
LA
Enumeration date
07/25/2006
Last updated
08/12/2020
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