Provider Demographics
NPI:1013965011
Name:BALDASSANO, MARISA FRANCES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:FRANCES
Last Name:BALDASSANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 CREEKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2729
Mailing Address - Country:US
Mailing Address - Phone:215-628-0855
Mailing Address - Fax:215-628-3559
Practice Address - Street 1:828 CREEKVIEW DR
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2729
Practice Address - Country:US
Practice Address - Phone:215-628-0855
Practice Address - Fax:215-628-3559
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072857L207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG92544Medicare UPIN
047763UATMedicare ID - Type Unspecified