Provider Demographics
NPI:1124418074
Name:MARIETTA, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MARIETTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROCK HILL DR
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1628
Mailing Address - Country:US
Mailing Address - Phone:215-364-9630
Mailing Address - Fax:
Practice Address - Street 1:800 ROCK HILL DR
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1628
Practice Address - Country:US
Practice Address - Phone:215-364-9630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10023186247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other