Provider Demographics
NPI:1245237981
Name:MARRARA, ANTHONY W (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:W
Last Name:MARRARA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:J
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2820 BENNER PIKE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-8435
Mailing Address - Country:US
Mailing Address - Phone:814-355-1119
Mailing Address - Fax:814-353-9144
Practice Address - Street 1:2820 BENNER PIKE
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-8435
Practice Address - Country:US
Practice Address - Phone:814-355-1119
Practice Address - Fax:814-353-9144
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
PADC003514L111N00000X
PADC008872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019172440001Medicaid
PA167853OtherBLUE SHIELD
PA1394440OtherBLUESHIELD
PA0010880500003Medicaid
PA167853KNEMedicare ID - Type Unspecified
DC003514LMedicare UPIN
PA0019172440001Medicaid
PA1394440OtherBLUESHIELD