Provider Demographics
NPI:1477756310
Name:HSIAO, MARVIN LEE (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:LEE
Last Name:HSIAO
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 1:4325 N. JOSEY LN.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4636
Mailing Address - Country:US
Mailing Address - Phone:972-395-7131
Mailing Address - Fax:972-395-7585
Practice Address - Street 1:4325 N. JOSEY LN.
Practice Address - Street 2:SUITE 103
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4636
Practice Address - Country:US
Practice Address - Phone:972-395-7131
Practice Address - Fax:972-395-7585
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2117207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0022426OtherINSTITUTIONAL PERMIT
TX205515401Medicaid