Provider Demographics
NPI:1992963953
Name:SMALLEY, MARIANNE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:LEE
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIANNE
Other - Middle Name:LEE
Other - Last Name:WHEATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:17TH AND CHEW STREETS
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:610-969-2226
Practice Address - Fax:610-969-9623
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434447207P00000X
OH096643207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021898460001Medicaid
NJ0167541Medicaid
PA128588PAGMedicare PIN