Provider Demographics
NPI:1083678312
Name:SANGALLI, MARC ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALAN
Last Name:SANGALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 REGIONAL MEDICAL DR STE 1319
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-1413
Mailing Address - Country:US
Mailing Address - Phone:713-486-7630
Mailing Address - Fax:979-532-6790
Practice Address - Street 1:2112 REGIONAL MEDICAL DR STE 1319
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-1413
Practice Address - Country:US
Practice Address - Phone:713-486-7630
Practice Address - Fax:979-532-6790
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160039180OtherRAILROAD GBA - RAILROAD MEDICARE
TX8DE545OtherBC/BS#
TX85Z654OtherBC/BS TX#
TX118843501Medicaid
TX118843507Medicaid
TXG30197Medicare UPIN
TX85Z654Medicare ID - Type Unspecified
TX118843501Medicaid