Provider Demographics
NPI:1154391332
Name:MARRA, TIMOTHY E (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:E
Last Name:MARRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N EL DORADO PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4606
Mailing Address - Country:US
Mailing Address - Phone:520-327-5677
Mailing Address - Fax:520-325-2335
Practice Address - Street 1:1110 N EL DORADO PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4606
Practice Address - Country:US
Practice Address - Phone:520-327-5677
Practice Address - Fax:520-325-2335
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007910207W00000X
PAOS014796207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ534616Medicaid
PA154711Medicare PIN
PA102320511Medicaid