Provider Demographics
NPI:1669433173
Name:LISTENGARTEN, DMITRY V (MD)
Entity type:Individual
Prefix:
First Name:DMITRY
Middle Name:V
Last Name:LISTENGARTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3311
Mailing Address - Country:US
Mailing Address - Phone:210-575-8229
Mailing Address - Fax:210-575-8127
Practice Address - Street 1:8550 HUEBNER ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3915
Practice Address - Country:US
Practice Address - Phone:210-541-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ340572084P0800X
TXM01522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CH279OtherBCBS
TX8DJ858OtherBCBS
AZ942236Medicaid
TX212157603Medicaid
Z113509Medicare PIN
I33149Medicare UPIN
AZ942236Medicaid
TXTXB101725Medicare PIN
Z103938Medicare PIN