Provider Demographics
NPI:1609166016
Name:DALGO, AUSTIN LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:LAWRENCE
Last Name:DALGO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 CRESTHAVEN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0809
Mailing Address - Country:US
Mailing Address - Phone:901-866-8864
Mailing Address - Fax:
Practice Address - Street 1:870 E MCLEMORE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-3218
Practice Address - Country:US
Practice Address - Phone:901-448-2200
Practice Address - Fax:901-448-8485
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51976207QH0002X, 207RH0002X, 2080H0002X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine