Active NPI
Marissa Lynn Dallara, MD
- Surgery Physician
- Allentown, PA
National Provider Identifier
1033964440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MT230566
- Practice address
- 1200 S Cedar Crest Blvd
Allentown, PA 18103-6202 - Phone
- (610) 402-8000
- NPI assigned
- Apr 19, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MT230566 | PA | Primary |
Addresses
Primary practice location
1200 S Cedar Crest Blvd
Allentown, PA 18103-6202
Mailing address
6110 Reese Rd Apt 310
Davie, FL 33314-1249
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240829004087 | PA | Order and Referring Only - General Surgery | 4385183631 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT230566 | PA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713484800000",
"number": "1033964440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6110 REESE RD APT 310",
"city": "DAVIE",
"state": "FL",
"postal_code": "333141249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 S CEDAR CREST BLVD",
"city": "ALLENTOWN",
"state": "PA",
"postal_code": "181036202",
"telephone_number": "610-402-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALLARA",
"first_name": "MARISSA",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-19",
"last_updated": "2024-04-19",
"certification_date": "2024-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": "MT230566",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Allentown, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.