Provider Demographics
NPI:1629283270
Name:MARY ANGELA KNAUSS MD PA
Entity Type:Organization
Organization Name:MARY ANGELA KNAUSS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:KNAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-485-9533
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00820YMedicare ID - Type Unspecified
TXE10099Medicare UPIN