Provider Demographics
NPI:1700113040
Name:MARNI L MENTIS DO PA
Entity Type:Organization
Organization Name:MARNI L MENTIS DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARNI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MENTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-474-0205
Mailing Address - Street 1:401 CORBETT ST
Mailing Address - Street 2:SUSITE 310
Mailing Address - City:BELLEAIR
Mailing Address - State:FL
Mailing Address - Zip Code:33756-7309
Mailing Address - Country:US
Mailing Address - Phone:727-474-0205
Mailing Address - Fax:727-474-9179
Practice Address - Street 1:401 CORBETT ST
Practice Address - Street 2:SUSITE 310
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-7309
Practice Address - Country:US
Practice Address - Phone:727-474-0205
Practice Address - Fax:727-474-9179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8521208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS8521OtherMEDICAL LICENSE