Basic Information
| Provider Information | |||||||||
| NPI: | 1770503583 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARRA | ||||||||
| FirstName: | NAEHAL | ||||||||
| MiddleName: | PATEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135B MIDWAY DR | ||||||||
| Address2: | |||||||||
| City: | DU BOIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158013857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143711771 | ||||||||
| FaxNumber: | 8143714417 | ||||||||
| Practice Location | |||||||||
| Address1: | 135B MIDWAY DR | ||||||||
| Address2: | |||||||||
| City: | DU BOIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158013857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143711771 | ||||||||
| FaxNumber: | 8143714417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 10/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 20A8402 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080A0000X | OS013751 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001879354 | 01 | PA | HIGHMARK INDIVIDUAL PROVIDER NUMBER | OTHER | 101731700 | 05 | PA | MEDICAID |