Provider Demographics
NPI:1306007729
Name:MARIETTA, RICHARD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:MARIETTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 BLOSSOM ST
Mailing Address - Street 2:STE 400
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4204
Mailing Address - Country:US
Mailing Address - Phone:281-604-1300
Mailing Address - Fax:281-724-0225
Practice Address - Street 1:250 BLOSSOM ST
Practice Address - Street 2:STE 400
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4204
Practice Address - Country:US
Practice Address - Phone:281-604-1300
Practice Address - Fax:281-724-0225
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2022-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE4505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B24637Medicare UPIN