Basic Information
Provider Information
NPI: 1881640175
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARRACCINI
FirstName: RORY
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1605 N CEDAR CREST BLVD STE 411
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181042323
CountryCode: US
TelephoneNumber: 6109691914
FaxNumber: 6109693951
Practice Location
Address1: 1259 S CEDAR CREST BLVD STE 230
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181036376
CountryCode: US
TelephoneNumber: 6104025900
FaxNumber: 6104024650
Other Information
ProviderEnumerationDate: 05/26/2006
LastUpdateDate: 05/07/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/07/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XMD420846PAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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