Provider Demographics
NPI:1710046206
Name:VISCARDI, MARJORIE E (MD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:E
Last Name:VISCARDI
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 1:706 W BEN WHITE BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8144
Mailing Address - Country:US
Mailing Address - Phone:512-334-2509
Mailing Address - Fax:512-334-2589
Practice Address - Street 1:5701 W SLAUGHTER LN BLDG C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-6528
Practice Address - Country:US
Practice Address - Phone:512-334-2509
Practice Address - Fax:512-334-2589
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54566207Q00000X
TXJ2400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135951509Medicaid
TXJ2400OtherMEDICAL LICENSE
TXP01330571OtherRRMC PTAN
TXP01330571OtherRRMC PTAN
TXF92919Medicare UPIN
TX135951509Medicaid