Individual provider Active NPI

Marissa Lauren Villano, PA-C

  • Surgical Physician Assistant
  • Erie, PA
National Provider Identifier
1083545271
Registry record updated Jul 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
MA067804 Issued in PA
Practice address
2508 Myrtle St Ste 100
Erie, PA 16502-2700
Phone
(833) 246-7662
NPI assigned
May 26, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X MA067804 PA Primary
Physician Assistant 363A00000X MA067804 PA

Addresses

Primary practice location

2508 Myrtle St Ste 100
Erie, PA 16502-2700

Mailing address

2508 Myrtle St Ste 100
Erie, PA 16502-2700
Phone (833) 246-7662

Other identifiers 1

IdentifierTypeStateIssuer
16876839OtherCAQH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MA067804PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Allegheny Clinic Medical Oncology PastSince Mar 20, 2024 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1779753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785369600000",
    "number": "1083545271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2508 MYRTLE ST STE 100",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022700",
            "telephone_number": "833-246-7662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 MYRTLE ST STE 100",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022700",
            "telephone_number": "833-246-7662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLANO",
        "first_name": "MARISSA",
        "middle_name": "LAUREN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-05-26",
        "last_updated": "2026-07-30",
        "certification_date": "2026-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA067804",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA067804",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "16876839",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.