Provider Demographics
NPI:1396705398
Name:MARCONI, ANDREA (DO, MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MARCONI
Suffix:
Gender:M
Credentials:DO, MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MARCONI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:921 GESSNER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2501
Mailing Address - Country:US
Mailing Address - Phone:713-242-3070
Mailing Address - Fax:
Practice Address - Street 1:921 GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2501
Practice Address - Country:US
Practice Address - Phone:713-242-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235825207P00000X
TXM1228207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177291504Medicaid
TX177291510Medicaid
TX177291506Medicaid
I45129Medicare UPIN
TX177291510Medicaid
TX8J8973Medicare PIN
TX177291504Medicaid
TX8G5035Medicare PIN