Provider Demographics
NPI:1225259666
Name:CURRY, MARISSA BANATWALA (MD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:BANATWALA
Last Name:CURRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 NORTH ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1433
Mailing Address - Country:US
Mailing Address - Phone:409-354-7900
Mailing Address - Fax:
Practice Address - Street 1:3030 NORTH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1433
Practice Address - Country:US
Practice Address - Phone:409-354-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX541700ZXCYMedicare PIN
TX8M7386OtherBCBS TX
TX191569601Medicaid
TXP00463473Medicare PIN