Provider Demographics
NPI:1063583359
Name:MARLA, RAMMOHAN (MD)
Entity type:Individual
Prefix:
First Name:RAMMOHAN
Middle Name:
Last Name:MARLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 W HOSPITAL DR STE 205
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7822
Mailing Address - Country:US
Mailing Address - Phone:520-575-6944
Mailing Address - Fax:520-575-1115
Practice Address - Street 1:2055 W HOSPITAL DR STE 205
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7822
Practice Address - Country:US
Practice Address - Phone:520-575-6944
Practice Address - Fax:520-575-1115
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58208208G00000X
IL036134953208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063583359OtherTRICARE
IA1063583359Medicaid
1063583359OtherWELLMARK BC/BS
1063583359OtherTRICARE
IA20301002Medicare PIN
ILF100214091Medicare PIN