Provider Demographics
NPI:1003277195
Name:MARK CIAGLIA, DO PC
Entity Type:Organization
Organization Name:MARK CIAGLIA, DO PC
Other - Org Name:WOODLANDS CENTER FOR SPECIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CIAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:936-242-1437
Mailing Address - Street 1:134 VISION PARK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3030
Mailing Address - Country:US
Mailing Address - Phone:936-242-1437
Mailing Address - Fax:936-447-9672
Practice Address - Street 1:134 VISION PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3030
Practice Address - Country:US
Practice Address - Phone:936-242-1437
Practice Address - Fax:936-447-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3667456Medicaid