Provider Demographics
NPI:1467560029
Name:MARAIST, TODD ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ANTHONY
Last Name:MARAIST
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 1:17200 ST LUKES WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8007
Mailing Address - Country:US
Mailing Address - Phone:936-266-2000
Mailing Address - Fax:
Practice Address - Street 1:4421 HWY 6 SOUTH
Practice Address - Street 2:STE 100
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845
Practice Address - Country:US
Practice Address - Phone:979-690-4470
Practice Address - Fax:979-690-4471
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012739942084N0400X
TXH6405208VP0000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130461003Medicaid
TX00N38VOtherBCBS OF TEXAS
TX00N38VOtherBCBS OF TEXAS
TX130010693Medicare PIN
TX130461003Medicaid