Provider Demographics
NPI:1851456529
Name:MATTIOLI, MARTHA X (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:MATTIOLI
Suffix:X
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 1:3413 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-1833
Mailing Address - Country:US
Mailing Address - Phone:713-225-1919
Mailing Address - Fax:713-224-3794
Practice Address - Street 1:3413 CANAL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-1833
Practice Address - Country:US
Practice Address - Phone:713-225-1919
Practice Address - Fax:713-224-3794
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097522Medicare UPIN