1558423947 NPI number — MRS. LYNN ANN MAAROUF RD,LD,CDE

Table of content: MRS. LYNN ANN MAAROUF RD,LD,CDE (NPI 1558423947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558423947 NPI number — MRS. LYNN ANN MAAROUF RD,LD,CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAAROUF
Provider First Name:
LYNN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD,LD,CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BALOGH
Provider Other First Name:
LYNN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, LD, CDE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558423947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIVERSITY OF TEXAS MEDICAL BR
Provider Second Line Business Mailing Address:
301 UNIVERSITY BLVD
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77555-1090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-539-8404
Provider Business Mailing Address Fax Number:
281-338-0805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2660 GULF FWY S
Provider Second Line Business Practice Location Address:
STARK DIABETES CENTER SUITE # 9
Provider Business Practice Location Address City Name:
LEAGUE CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77573-6820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-539-8404
Provider Business Practice Location Address Fax Number:
281-337-0805
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  DT06378 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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