Provider Demographics
NPI:1740591304
Name:DIDARIO, MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:DIDARIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2088
Practice Address - Country:US
Practice Address - Phone:888-285-2269
Practice Address - Fax:512-838-4264
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022076662084P0800X
MIEMC00043222084P0800X
ORDO1871032084P0800X
WI28-3212084P0800X
TN49602084P0800X
MO20190141302084P0800X
MN639702084P0800X
TXR36602084P0800X
WAOP608721312084P0800X
MS262772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry