Provider Demographics
NPI:1033323878
Name:CUSICK, MARIANNE VANDROMME (MD, MSPH)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:VANDROMME
Last Name:CUSICK
Suffix:
Gender:F
Credentials:MD, MSPH
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:JOSEPHINE
Other - Last Name:VANDROMME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MSPH
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 2307
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-486-4600
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 2307
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-486-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0622208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338173302Medicaid
TX338173302Medicaid