Provider Demographics
NPI:1710971965
Name:KANTARAS, MARLA A (MD)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:A
Last Name:KANTARAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:A
Other - Last Name:OCCHINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4575 EVERHARD RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2406
Mailing Address - Country:US
Mailing Address - Phone:330-494-5600
Mailing Address - Fax:330-966-1644
Practice Address - Street 1:4575 EVERHARD RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2406
Practice Address - Country:US
Practice Address - Phone:330-494-5600
Practice Address - Fax:330-966-1644
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350738555208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2057018Medicaid