Healthcare Provider Details

I. General information

NPI: 1013965011
Provider Name (Legal Business Name): MARISA FRANCES BALDASSANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HILLCREST LANE
LOWER GWYNEDD PA
19002
US

IV. Provider business mailing address

101 HILLCREST LANE
LOWER GWYNEDD PA
19002
US

V. Phone/Fax

Practice location:
  • Phone: 215-628-0855
  • Fax: 215-628-3559
Mailing address:
  • Phone: 215-628-0855
  • Fax: 215-628-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD072857L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: