Provider Demographics
NPI:1508014697
Name:MARAPOSA SURGICAL INC.
Entity Type:Organization
Organization Name:MARAPOSA SURGICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:TAHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-368-8490
Mailing Address - Street 1:900 CHESTNUT STREET EXT
Mailing Address - Street 2:STE A
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2298
Mailing Address - Country:US
Mailing Address - Phone:814-368-8490
Mailing Address - Fax:814-368-8041
Practice Address - Street 1:900 CHESTNUT STREET EXT
Practice Address - Street 2:STE A
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2298
Practice Address - Country:US
Practice Address - Phone:814-368-8490
Practice Address - Fax:814-368-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419351208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty