Provider Demographics
NPI:1417063991
Name:DELLARIA, MARCO FRANK (MD)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:FRANK
Last Name:DELLARIA
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:PO BOX 660132
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0132
Mailing Address - Country:US
Mailing Address - Phone:214-366-6126
Mailing Address - Fax:214-366-6127
Practice Address - Street 1:1420 VICEROY DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2208
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-366-6127
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL43302085R0204X
AL000228842085R0204X
IL036-0986012085R0204X
OH350727632085R0204X
PAMD058818L2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147791101Medicaid
TX147791101Medicaid
TXG44229Medicare UPIN