Provider Demographics
NPI:1760414239
Name:SACKLER, MARIAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:E
Last Name:SACKLER
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 1:712 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1619
Mailing Address - Country:US
Mailing Address - Phone:214-823-6503
Mailing Address - Fax:214-826-0605
Practice Address - Street 1:712 N WASHINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1619
Practice Address - Country:US
Practice Address - Phone:214-823-6503
Practice Address - Fax:214-826-0605
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4493207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCP7207OtherMEDICARE RAILROAD
TXCP7207OtherMEDICARE RAILROAD
TXF74348Medicare UPIN