Provider Demographics
NPI:1790929040
Name:SISSA, MARTHA MAE (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MAE
Last Name:SISSA
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 1:8540 BROADWAY ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7710
Mailing Address - Country:US
Mailing Address - Phone:832-582-7146
Mailing Address - Fax:832-962-8154
Practice Address - Street 1:8540 BROADWAY ST STE 205
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7710
Practice Address - Country:US
Practice Address - Phone:832-582-7146
Practice Address - Fax:832-962-8154
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7229208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1790929040OtherUNITED HEALTHCARE
TX1790929040OtherBCBS OF TEXAS