Provider Demographics
NPI:1962418947
Name:DAIT, MARIANNE TANTOCO (DO)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:TANTOCO
Last Name:DAIT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:DAIT
Other - Last Name:EVERETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2246 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3559
Practice Address - Country:US
Practice Address - Phone:804-642-6171
Practice Address - Fax:804-642-5656
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine