Healthcare Provider Details

I. General information

NPI: 1356847271
Provider Name (Legal Business Name): MARIA MARVASSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4259 W SWAMP RD
DOYLESTOWN PA
18902-1033
US

IV. Provider business mailing address

1 STONEHAM RD
COLLEGEVILLE PA
19426-3419
US

V. Phone/Fax

Practice location:
  • Phone: 215-345-2535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP018357
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP018357
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: