Provider Demographics
NPI:1306331442
Name:DALIMONTE, MERRIA NOVIA (PA)
Entity type:Individual
Prefix:
First Name:MERRIA
Middle Name:NOVIA
Last Name:DALIMONTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 S HARVARD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2929
Mailing Address - Country:US
Mailing Address - Phone:918-747-5565
Mailing Address - Fax:918-747-5568
Practice Address - Street 1:4612 S HARVARD AVE STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2908
Practice Address - Country:US
Practice Address - Phone:918-747-5565
Practice Address - Fax:918-747-5568
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28422084P0800X, 2084P0804X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200781730AMedicaid
L083271809OtherDRIVERS LICENSE