Provider Demographics
NPI:1558423947
Name:MAAROUF, LYNN ANN (RD,LD,CDE)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ANN
Last Name:MAAROUF
Suffix:
Gender:F
Credentials:RD,LD,CDE
Other - Prefix:MISS
Other - First Name:LYNN
Other - Middle Name:A
Other - Last Name:BALOGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, CDE
Mailing Address - Street 1:UNIVERSITY OF TEXAS MEDICAL BR
Mailing Address - Street 2:301 UNIVERSITY BLVD
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1090
Mailing Address - Country:US
Mailing Address - Phone:409-539-8404
Mailing Address - Fax:281-338-0805
Practice Address - Street 1:2660 GULF FWY S
Practice Address - Street 2:STARK DIABETES CENTER SUITE # 9
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6820
Practice Address - Country:US
Practice Address - Phone:409-539-8404
Practice Address - Fax:281-337-0805
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A0589Medicare ID - Type Unspecified
TXP70996Medicare UPIN