Provider Demographics
NPI:1699942359
Name:PALLENS, MARA ANGELIE (MD)
Entity type:Individual
Prefix:DR
First Name:MARA
Middle Name:ANGELIE
Last Name:PALLENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARA
Other - Middle Name:ANGELIE
Other - Last Name:PALLENS-FELICIANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:400 N ASHLEY DR
Mailing Address - Street 2:STE 1625
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4300
Mailing Address - Country:US
Mailing Address - Phone:813-289-6597
Mailing Address - Fax:865-769-3454
Practice Address - Street 1:400 N ASHLEY DR
Practice Address - Street 2:STE 1625
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4300
Practice Address - Country:US
Practice Address - Phone:813-289-6597
Practice Address - Fax:865-769-3454
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20584207RI0200X
FLME130470207R00000X
PR28176R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease