Provider Demographics
NPI:1982871810
Name:JAMES P. MARRA, M.D., APMC
Entity Type:Organization
Organization Name:JAMES P. MARRA, M.D., APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-391-7580
Mailing Address - Street 1:120 MEADOWCREST ST STE 380
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5281
Mailing Address - Country:US
Mailing Address - Phone:504-391-7580
Mailing Address - Fax:504-391-7586
Practice Address - Street 1:120 MEADOWCREST ST STE 380
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5281
Practice Address - Country:US
Practice Address - Phone:504-391-7580
Practice Address - Fax:504-391-7586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1112348Medicaid
LA080161096OtherPALMETTO GBA RAILROAD MEDICARE
B65558Medicare UPIN
LA080161096OtherPALMETTO GBA RAILROAD MEDICARE