Provider Demographics
NPI:1356643597
Name:TOM, MARIAN KARA (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:KARA
Last Name:TOM
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:DR
Other - First Name:MARE
Other - Middle Name:
Other - Last Name:TOM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO MPH
Mailing Address - Street 1:95 STEVENSON ST
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1113
Mailing Address - Country:US
Mailing Address - Phone:323-712-5673
Mailing Address - Fax:
Practice Address - Street 1:95 STEVENSON ST
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1113
Practice Address - Country:US
Practice Address - Phone:323-712-5673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAS7163304-778208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery