Provider Demographics
NPI:1881639029
Name:TAWADROUS, MARIANA M (DO)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:M
Last Name:TAWADROUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:M
Other - Last Name:AGAIBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2340 E TRINITY MILLS RD STE 250
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1946
Mailing Address - Country:US
Mailing Address - Phone:469-620-0811
Mailing Address - Fax:940-222-2720
Practice Address - Street 1:2340 E TRINITY MILLS RD STE 250
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1946
Practice Address - Country:US
Practice Address - Phone:469-620-0811
Practice Address - Fax:940-222-2720
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4484207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43492900Medicaid
WIH40281Medicare UPIN
WI46236-0091Medicare PIN
WI43492900Medicaid