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General NPI Number Information
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NPI Number | 1629677497
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Entity Type | Individual
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Provider Name | MARISSA LEIGH BERLANT PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 3400 SPRUCE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4238
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Country | US
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Telephone | 215-316-5151
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 SPRUCE STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3309
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Country | US
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Telephone | 215-349-8310
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Fax | 215-893-7270
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA061887
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License Number State | PA
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