Provider Demographics
NPI:1538747753
Name:ERNST, MARA (DO)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:ERNST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:
Other - Last Name:LEYENDECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:UC HEALTH DERMATOLOGY
Mailing Address - Street 2:3130 HIGHLAND AVE
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-584-4644
Mailing Address - Fax:513-584-1559
Practice Address - Street 1:1475 W 49TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3113
Practice Address - Country:US
Practice Address - Phone:305-558-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH34.016652207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207N00000XAllopathic & Osteopathic PhysiciansDermatology