Provider Demographics
NPI:1801922919
Name:OSHAE, MARNE (MD)
Entity type:Individual
Prefix:
First Name:MARNE
Middle Name:
Last Name:OSHAE
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 1:4 SANCTUARY DR # 2
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1976
Mailing Address - Country:US
Mailing Address - Phone:607-273-5551
Mailing Address - Fax:607-275-0313
Practice Address - Street 1:4 SANCTUARY DR # 2
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1976
Practice Address - Country:US
Practice Address - Phone:607-273-5551
Practice Address - Fax:607-275-0313
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228335-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBO8382789OtherDEA NO.
NYH96470Medicare UPIN
NYIA0907Medicare PIN