Provider Demographics
NPI:1407103393
Name:MARCHESANO, CRISTINA ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:ROSE
Last Name:MARCHESANO
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:920 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3260
Mailing Address - Country:US
Mailing Address - Phone:281-298-1144
Mailing Address - Fax:281-298-1133
Practice Address - Street 1:920 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 120
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3260
Practice Address - Country:US
Practice Address - Phone:281-298-1144
Practice Address - Fax:281-298-1133
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP40802080P0006X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX306370303Medicaid