Provider Demographics
NPI:1578527214
Name:CITARDI, MARTIN J (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:CITARDI
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 1:6431 FANNIN STREET, MSB 5.036
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-0541
Mailing Address - Fax:
Practice Address - Street 1:6400 FANNIN ST
Practice Address - Street 2:SUITE 2700
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1521
Practice Address - Country:US
Practice Address - Phone:713-465-5000
Practice Address - Fax:713-383-1410
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2022-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078802C207Y00000X
TXM8607207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH040015678OtherMEDICARE RAILROAD
OH2212019Medicaid
TX8BD690OtherBCBSTX
TXM8607 207Y00000XOtherTX LICENSE & PRIMARY TAXOMONY
TX193763301Medicaid
TX8BD690OtherBCBSTX
OHG47896Medicare UPIN
OH2212019Medicaid
OHCI7347341Medicare PIN