1932107067 NPI number — DR. MARCO A GIANNOTTI M. D.

Table of content: DR. MARCO A GIANNOTTI M. D. (NPI 1932107067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932107067 NPI number — DR. MARCO A GIANNOTTI M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIANNOTTI
Provider First Name:
MARCO
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M. D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1932107067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9180 PINECROFT DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHENANDOAH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77380-3880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-367-6836
Provider Business Mailing Address Fax Number:
281-367-5545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9180 PINECROFT DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-367-6836
Provider Business Practice Location Address Fax Number:
281-367-5545
Provider Enumeration Date:
07/12/2005

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: 174400000X , with the licence number:  J7331 , 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)

  • Identifier: 4754569-014 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5621502 . This is a "AETNA PPO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 113215106 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31892 . This is a "AMERICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3231889 . This is a "AETNA HMO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4754569-012 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4754569-013 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8J1224 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00063148 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P43964651 . This is a "MULTIPLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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