1851415004 NPI number — AVI B MARKOWITZ, MD, PA

Table of content: (NPI 1851415004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851415004 NPI number — AVI B MARKOWITZ, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVI B MARKOWITZ, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851415004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2617 GEROL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77551-1529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-741-0030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 UNIVERSITY DR E
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
BRYAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77802-3475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-731-8558
Provider Business Practice Location Address Fax Number:
979-731-8654
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARKOWITZ
Authorized Official First Name:
AVI
Authorized Official Middle Name:
BART
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
979-731-8558

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00T30E . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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