Provider Demographics
NPI:1144222159
Name:INTERIANO, BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:INTERIANO
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 1:9380 W SAM HOUSTON PKWY S STE 225
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-5230
Mailing Address - Country:US
Mailing Address - Phone:281-674-1700
Mailing Address - Fax:281-674-1710
Practice Address - Street 1:9380 W SAM HOUSTON PKWY S STE 225
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-5230
Practice Address - Country:US
Practice Address - Phone:281-674-1700
Practice Address - Fax:281-674-1710
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6858207RP1001X, 207R00000X
TX6858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128116406Medicaid
TX00494MMedicare PIN
TX128116406Medicaid