1376725150 NPI number — DR. STUART MARMORSTEIN

Table of content: MADELINNE DIANNE METTS (NPI 1679269005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376725150 NPI number — DR. STUART MARMORSTEIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARMORSTEIN
Provider First Name:
STUART
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARMORSTEIN
Provider Other First Name:
STU
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1376725150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5925 KIRBY DR
Provider Second Line Business Mailing Address:
STE E633
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77005-3150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-831-6875
Provider Business Mailing Address Fax Number:
775-254-2757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3730 KIRBY DR
Provider Second Line Business Practice Location Address:
STE 1200
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77098-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-831-6875
Provider Business Practice Location Address Fax Number:
775-254-2757
Provider Enumeration Date:
12/03/2007

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: 111N00000X , with the licence number:  9685 , 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)