NPIMap

Individual provider Active NPI

Marianne Rallas

  • Medical Physician Assistant
  • Frederick, MD
National Provider Identifier
1376570853
Registry record updated Jul 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
C01065 Issued in MD
Practice address
501 W 7TH St
Frederick, MD 21701
Phone
(301) 698-8374
Fax
(240) 439-8910
NPI assigned
Jun 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X C0001065 MD
Medical Physician Assistant 363AM0700X C01065 MD Primary

Addresses

Primary practice location

501 W 7TH St
Frederick, MD 21701

Mailing address

PO Box 37086
Baltimore, MD 21297-3086
Phone (240) 439-8913

Other practice location 1

85 Thomas Johnson Ct
Suite B
Frederick, MD 21702-4331
Phone (301) 663-9440 ext. 210

Other practice location 2

85 Thomas Johnson Ct
Suite B
Frederick, MD 21702-4331
Phone (301) 663-9440 ext. 210

Other identifiers 1

IdentifierTypeStateIssuer
762671100MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C01065MDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Frederick Health Hospital Inc Past Accepting new patients
Emergency Physician Associates, PA Past Accepting new patients

Organizations & group practices 2

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": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564444800000",
    "number": "1376570853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37086",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212973086",
            "telephone_number": "240-439-8913",
            "fax_number": "240-439-8910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 W 7TH ST",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "21701",
            "telephone_number": "301-698-8374",
            "fax_number": "240-439-8910"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "85 Thomas Johnson Ct",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Frederick",
            "state": "MD",
            "postal_code": "217024331",
            "country_code": "US",
            "telephone_number": "301-663-9440 x210",
            "fax_number": "301-663-4602",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "85 Thomas Johnson Ct",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Frederick",
            "state": "MD",
            "postal_code": "217024331",
            "country_code": "US",
            "telephone_number": "301-663-9440 x210",
            "fax_number": "301-663-4602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RALLAS",
        "first_name": "MARIANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2019-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MD",
            "license": "C0001065",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C01065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "762671100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.