Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mackenzie Carolyn Waltz Dallaire, PA-C

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1164188520

Mackenzie Carolyn Waltz Dallaire, PA-C is a Physician Assistant in Camden, New Jersey. Qualified in 2022, 4 years ago. Practices with Virtua Medical Group, PA, a 1,669-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in New Jersey and Pennsylvania.

Years since qualifying
4
Licensed in
NJ, PA
In the registry since
2021
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

Student / training record This NPI belongs to someone enrolled in a health care training programme. It carries no licence and no practice of its own, so no address or phone number is published for it.

Camden, NJ

Additional practice locations (1)

  • 4170 City Ave, Philadelphia, PA 19131-1610 — (301) 641-9213

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 25MP00728700 (NJ)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X (PA)

Record details

NPI number1164188520
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedNovember 10, 2021
Last updated in NPPESOctober 4, 2024
Certification dateOctober 4, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Virtua Medical Group, Pa — 1669 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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