Provider Demographics
NPI:1295807725
Name:MARRA, DANTE ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:DANTE
Middle Name:ANTHONY
Last Name:MARRA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WHARTON CIRCLE
Mailing Address - Street 2:STE 130
Mailing Address - City:TRIADELPHIA
Mailing Address - State:WV
Mailing Address - Zip Code:26059-1293
Mailing Address - Country:US
Mailing Address - Phone:304-242-8042
Mailing Address - Fax:
Practice Address - Street 1:300 WHARTON CIR STE 130
Practice Address - Street 2:
Practice Address - City:TRIADELPHIA
Practice Address - State:WV
Practice Address - Zip Code:26059-1293
Practice Address - Country:US
Practice Address - Phone:304-242-8042
Practice Address - Fax:304-242-8962
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441233207X00000X
WV19164207XX0005X, 207X00000X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0098600000Medicaid
OH2015269Medicaid
OH2015269Medicaid
OH0838472Medicare ID - Type Unspecified
WV0098600000Medicaid