Provider Demographics
NPI:1467452045
Name:KNAUSS, MARY ANGELA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANGELA
Last Name:KNAUSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77588-1256
Mailing Address - Country:US
Mailing Address - Phone:281-485-9533
Mailing Address - Fax:281-485-8234
Practice Address - Street 1:2800 BROADWAY ST
Practice Address - Street 2:SUITE H
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-9502
Practice Address - Country:US
Practice Address - Phone:281-485-9533
Practice Address - Fax:281-485-8234
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0098MHOtherBLUE CROSS/BLUE SHIELD TX
TX8F0017Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
TX00820YMedicare ID - Type UnspecifiedGROUP NUMBER
TXE10099Medicare UPIN