Provider Demographics
NPI:1689604142
Name:CLINE, MARRIETTA D (MD)
Entity Type:Individual
Prefix:
First Name:MARRIETTA
Middle Name:D
Last Name:CLINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 FM 517 RD W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-3904
Mailing Address - Country:US
Mailing Address - Phone:281-534-1300
Mailing Address - Fax:281-534-1306
Practice Address - Street 1:624 FM 517 RD W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3904
Practice Address - Country:US
Practice Address - Phone:281-534-1300
Practice Address - Fax:281-534-1306
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0017QDOtherBC/BS
TX00424OtherTEXAS CHIP
TX00606GOtherMEDICARE ID
TX00002OtherAETNA EDI PROVIDER ID
TX121246602Medicaid
TX10024877OtherAMERIGROUP
TX121246604Medicaid
TX0017QDOtherBC/BS
TXG37743Medicare UPIN