Provider Demographics
NPI:1770503583
Name:MARRA, NAEHAL PATEL (DO)
Entity Type:Individual
Prefix:DR
First Name:NAEHAL
Middle Name:PATEL
Last Name:MARRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135B MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3857
Mailing Address - Country:US
Mailing Address - Phone:814-371-1771
Mailing Address - Fax:814-371-4417
Practice Address - Street 1:135B MIDWAY DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3857
Practice Address - Country:US
Practice Address - Phone:814-371-1771
Practice Address - Fax:814-371-4417
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8402208000000X
PAOS0137512080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001879354OtherHIGHMARK INDIVIDUAL PROVIDER NUMBER
PA101731700Medicaid
PA101731700Medicaid