Individual provider Active NPI

Marc Travis Latta, PA-C

  • Physician Assistant
  • Newark, DE
National Provider Identifier
1700985769
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-13626 Issued in NC
Practice address
4755 Ogletown Stanton Rd
Suite 1E50
Newark, DE 19718-2200
Phone
(302) 733-1980
Fax
(302) 733-1986
NPI assigned
Sep 22, 2006
Last updated
Dec 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110001154 VA
Physician Assistant 363A00000X C5-0001013 DE
Physician Assistant 363A00000X 0010-13626 NC Primary

Addresses

Primary practice location

4755 Ogletown Stanton Rd
Suite 1E50
Newark, DE 19718-2200

Mailing address

200 Hygeia Dr
Suite 2300
Newark, DE 19713-2049

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE, NC2 enrollments
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.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150825004419 DE Practitioner - Physician Assistant 7315013992 Reassigns benefits to 1 organization
I20241226001970 NC Practitioner - Physician Assistant 7315013992 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christiana Care Health Services IncGroup PAC ID 9739097569, 1,480 clinicians

Practice addresses (Care Compare)

4755 Ogletown Stanton Rd
Newark, DE 19718-2200

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Medical Group, Inc. CurrentSince Nov 20, 2024 Accepting new patients
Christiana Care Health Services, Inc CurrentSince Aug 24, 2015 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Nov 20, 2024 Accepting new patients
Moses Cone Medical Services, Inc. CurrentSince Dec 1, 2024 Accepting new patients
Christiana Care Health Services Inc CurrentSince Aug 24, 2015 Accepting new patients
Novant Medical Group, Inc. Past Accepting new patients

Locations

200 Hygeia Dr
Ste 2300
Newark, DE 19713
Phone (302) 623-7362

4755 Ogletown Stanton Rd
#1E50
Newark, DE 19718
Phone (302) 733-1980

4755 Ogletown Stanton Rd
Ste 1E50
Newark, DE 19718
Phone (302) 733-1980

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

1918 Randolph Rd
Ste 580
Charlotte, NC 28207
Phone (704) 333-9113

1126 N Church St
Ste 300
Greensboro, NC 27401
Phone (336) 547-1700

300 E Wendover Ave
Greensboro, NC 27401
Phone (336) 663-5205

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

940 Golf House Ct E
Whitsett, NC 27377
Phone (336) 449-9848

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: mlatta1631698@direct.novanthealth.org

Organizations & group practices 9

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1700985769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HYGEIA DR",
            "address_2": "SUITE 2300",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197132049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD",
            "address_2": "SUITE 1E50",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-733-1980",
            "fax_number": "302-733-1986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATTA",
        "first_name": "MARC",
        "middle_name": "TRAVIS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110001154",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0001013",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-13626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.