MEDICARE: DR. NAEHAL PATEL MARRA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	20A8402	CA
2	2080A0000X	Pediatric Adolescent Medicine Physician	OS013751	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001879354	OTHER	PA	HIGHMARK INDIVIDUAL PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770503583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAEHAL PATEL MARRA D.O.

Provider Business Mailing Address
First Line	:	135B MIDWAY DR
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-3857
Country	:	US
Telephone Number	:	814-371-1771
Fax Number	:	814-371-4417

Provider Business Practice Location Address
First Line	:	135B MIDWAY DR
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-3857
Country	:	US
Telephone Number	:	814-371-1771
Fax Number	:	814-371-4417

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	10/29/2015

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