Provider Demographics
NPI:1790773067
Name:VON-MASZEWSKI, MARIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
Last Name:VON-MASZEWSKI
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:PO BOX 1831
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-0046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:SUITE 1500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:713-790-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8223207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AA125OtherBLUE CROSS BLUE SHIELD
TX165294303Medicaid
TX165294307 (MDACC)Medicaid
TX8DF413OtherBCBS (MDACC)
TX8J8010Medicare PIN
TXTXB150508 (MDACC)Medicare PIN
TX8DF413OtherBCBS (MDACC)