Healthcare Provider Details

I. General information

NPI: 1013820125
Provider Name (Legal Business Name): MARALIE VAN DYK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 E JEFFERSON ST STE A2
BUTLER PA
16001-4780
US

IV. Provider business mailing address

PO BOX 641031
PITTSBURGH PA
15264-1031
US

V. Phone/Fax

Practice location:
  • Phone: 833-604-0435
  • Fax:
Mailing address:
  • Phone: 833-604-0435
  • Fax: 724-282-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT238563
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: