Provider Demographics
NPI:1750670840
Name:MARA OKSHTEYN, M.D.
Entity Type:Organization
Organization Name:MARA OKSHTEYN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MARA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-325-0822
Mailing Address - Street 1:PO BOX 430124
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243
Mailing Address - Country:US
Mailing Address - Phone:800-325-0822
Mailing Address - Fax:800-325-0822
Practice Address - Street 1:3328 EATON RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BROOK
Practice Address - State:AL
Practice Address - Zip Code:35223-6492
Practice Address - Country:US
Practice Address - Phone:800-325-0822
Practice Address - Fax:800-325-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982778643OtherINDIVIDUAL NPI
1982778643OtherINDIVIDUAL NPI