Provider Demographics
NPI:1538139019
Name:MARRA, ROBERT E (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:MARRA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1379 ENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5524
Mailing Address - Country:US
Mailing Address - Phone:860-741-3041
Mailing Address - Fax:860-741-5644
Practice Address - Street 1:1379 ENFIELD ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5524
Practice Address - Country:US
Practice Address - Phone:860-741-3041
Practice Address - Fax:860-741-5644
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000303213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0005083OtherTRICARE
030000303CT01OtherANTHEM
060309OtherCONNECTICARE
HAS376OtherOXFORD
0V0229OtherHEALTHNET
0452032-001OtherCIGNA
4212320OtherAETNA
480012879OtherMEDICARE RAILROAD
480012879OtherMEDICARE RAILROAD
HAS376OtherOXFORD
061159308OtherTIN
4212320OtherAETNA