Delaware Pediatrics Associates LLP
Required Field *
Please confirm you are paying your balance to Delaware Pediatrics located at 2550 Delaware Ave
Buffalo, NY 14216
Delaware Pediatrics Associates LLP
Additional Information
Patient Name *
Account Number *
Employee Name
Are you a patient *
Are you a patient
Yes
No
Billing Information
Credit Card Number *
Expiration *
CVV *
First Name *
Last Name *
USA
Street Address *
City *
State *
Select
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code *
Email Address
(For a copy of your receipt enter your email address. )
Payment Amount
Amount (Max $100,000.00)*
A
0
%
Credit Card Surcharge
will be applied to all credit card transactions. Debit and HSA/FSA transactions are not subject to a surcharge.
Submit Payment
.
.
.
Delaware Pediatrics Associates LLP
Return to Home
Print
Transaction Receipt
Merchant Information
Merchant
Provider | Location
Date/Time
Transaction ID
Transaction Type
Credit Card
Amount
$
Credit Card Surcharge
$
Total Amount
$
Credit Card Information
Type
Number
Billing Information
Name
Street Address
City, State, Zip Code
Additional Information