Provider Demographics
NPI:1902894280
Name:OBARA, MARLA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:
Last Name:OBARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 TROUBLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-5128
Mailing Address - Country:US
Mailing Address - Phone:727-847-5352
Mailing Address - Fax:727-847-3923
Practice Address - Street 1:5911 TROUBLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-5128
Practice Address - Country:US
Practice Address - Phone:727-847-5352
Practice Address - Fax:727-847-3923
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D21080Medicare UPIN
05977Medicare ID - Type Unspecified