MEDICARE: DR. JAMES P MARRA MD

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	174400000X	Specialist	009823	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080161096	OTHER	LA	PALMETTO GBA RAILROAD MED
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568467769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES P MARRA MD

Provider Business Mailing Address
First Line	:	120 MEADOWCREST ST
Second Line	:	STE 380
City	:	GRETNA
State	:	LA
Zip	:	70056-5281
Country	:	US
Telephone Number	:	504-391-7580
Fax Number	:	504-391-7586

Provider Business Practice Location Address
First Line	:	120 MEADOWCREST ST
Second Line	:	STE 380
City	:	GRETNA
State	:	LA
Zip	:	70056-5281
Country	:	US
Telephone Number	:	504-391-7580
Fax Number	:	504-391-7586

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	05/09/2008

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