Healthcare Provider Details

I. General information

NPI: 1750670840
Provider Name (Legal Business Name): MARA OKSHTEYN, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3328 EATON RD
MOUNTAIN BROOK AL
35223-6492
US

IV. Provider business mailing address

PO BOX 430124
VESTAVIA AL
35243
US

V. Phone/Fax

Practice location:
  • Phone: 800-325-0822
  • Fax: 800-325-0822
Mailing address:
  • Phone: 800-325-0822
  • Fax: 800-325-0822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36359
License Number StateAL

VIII. Authorized Official

Name: MARA OKSHTEYN
Title or Position: MD
Credential: MD
Phone: 800-325-0822