Provider Demographics
NPI:1275739906
Name:DALAKAS, MARINOS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARINOS
Middle Name:
Last Name:DALAKAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WALNUT STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-955-7000
Mailing Address - Fax:215-923-3504
Practice Address - Street 1:900 WALNUT ST FL 2
Practice Address - Street 2:JEFFERSON HOSPITAL FOR NEUROSCIENCES
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5509
Practice Address - Country:US
Practice Address - Phone:215-955-1234
Practice Address - Fax:215-503-2598
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4311002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4681801Medicaid
PA101935568Medicaid
PA101935568Medicaid