Provider Demographics
NPI:1326694597
Name:CALABRO, MARLA J (PA)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:J
Last Name:CALABRO
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:621 10TH ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1813
Mailing Address - Country:US
Mailing Address - Phone:716-278-4000
Mailing Address - Fax:
Practice Address - Street 1:620 10TH ST STE 704
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1841
Practice Address - Country:US
Practice Address - Phone:716-278-4402
Practice Address - Fax:716-278-4645
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY023924OtherNY LICENSE