Provider Demographics
NPI:1275697443
Name:PARADIS, MARA P (MD)
Entity Type:Individual
Prefix:DR
First Name:MARA
Middle Name:P
Last Name:PARADIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARA
Other - Middle Name:P
Other - Last Name:CHADWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:16929 FRANCES ST
Practice Address - Street 2:STE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4683
Practice Address - Country:US
Practice Address - Phone:402-758-5125
Practice Address - Fax:402-758-5283
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22293208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE05953OtherBCBS OF NE
NE250654OtherMIDLANDS CHOICE