Provider Demographics
NPI:1184711988
Name:SKAAR, MARNA M (MD)
Entity type:Individual
Prefix:
First Name:MARNA
Middle Name:M
Last Name:SKAAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S SAN MATEO DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3857
Mailing Address - Country:US
Mailing Address - Phone:650-342-5667
Mailing Address - Fax:650-342-7590
Practice Address - Street 1:50 S SAN MATEO DR
Practice Address - Street 2:SUITE 280
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3859
Practice Address - Country:US
Practice Address - Phone:650-342-5667
Practice Address - Fax:650-342-7590
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G561040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G561040OtherCA LICENSE
CA00G561040OtherCA LICENSE
CAE81994Medicare UPIN