Provider Demographics
NPI:1629404207
Name:MUHA, MARLA ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:ANN
Last Name:MUHA
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 1:301 HOSPITAL DR # 803
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5803
Mailing Address - Country:US
Mailing Address - Phone:410-553-8160
Mailing Address - Fax:410-553-8159
Practice Address - Street 1:255 HOSPITAL DR # 207
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5801
Practice Address - Country:US
Practice Address - Phone:410-553-8170
Practice Address - Fax:410-553-8171
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA168081363A00000X
363A00000X
MDC05196363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01365786OtherRAILROAD MEDICARE
OR500672853Medicaid
OR161133OtherGROUP MEDICAID NORTH BEND MEDICAL CENTER
ORR0000WFBTVOtherGROUP MEDICARE NORTH BEND MEDICAL CENTER
OR93-0635514OtherGROUP TAX ID NORTH BEND MEDICAL CENTER
OR1407812365OtherGROUP NPI NORTH BEND MEDICAL CENTER
OR500672853Medicaid