Provider Demographics
NPI:1407882715
Name:MARA, GEORGE ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ANTHONY
Last Name:MARA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 N ROAD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3282
Mailing Address - Country:US
Mailing Address - Phone:252-333-1149
Mailing Address - Fax:252-338-6503
Practice Address - Street 1:1507 N ROAD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3282
Practice Address - Country:US
Practice Address - Phone:252-333-1149
Practice Address - Fax:252-338-6503
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103992363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical