Provider Demographics
NPI:1568650620
Name:DONALD R. MARRAM, A PODIATRY CORPORATION
Entity type:Organization
Organization Name:DONALD R. MARRAM, A PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:209-835-4276
Mailing Address - Street 1:1542 N TRACY BLVD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-2903
Mailing Address - Country:US
Mailing Address - Phone:209-835-4276
Mailing Address - Fax:209-835-1017
Practice Address - Street 1:1542 N TRACY BLVD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2903
Practice Address - Country:US
Practice Address - Phone:209-835-4276
Practice Address - Fax:209-835-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1218213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10834Medicare UPIN