Provider Demographics
NPI:1790852671
Name:D'AMARA, MARYANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:
Last Name:D'AMARA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:MARYANN
Other - Middle Name:
Other - Last Name:DAMARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1001 MILDRED DRIVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-5045
Mailing Address - Country:US
Mailing Address - Phone:516-868-7699
Mailing Address - Fax:
Practice Address - Street 1:325 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2545
Practice Address - Country:US
Practice Address - Phone:631-320-1990
Practice Address - Fax:631-320-1988
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003628213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008068228Medicaid
T51155Medicare UPIN
NY008068228Medicaid