Provider Demographics
NPI:1588806343
Name:RENDELL, MARLA (MD)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:RENDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:
Other - Last Name:KOSYDAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 NE PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6063
Mailing Address - Country:US
Mailing Address - Phone:541-389-6313
Mailing Address - Fax:541-877-8760
Practice Address - Street 1:2200 NE PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6063
Practice Address - Country:US
Practice Address - Phone:541-389-6313
Practice Address - Fax:541-389-8760
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60340307208000000X
ORMD173334208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics