Provider Demographics
NPI:1932107067
Name:GIANNOTTI, MARCO A (M D)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:A
Last Name:GIANNOTTI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 PINECROFT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3880
Mailing Address - Country:US
Mailing Address - Phone:281-367-6836
Mailing Address - Fax:281-367-5545
Practice Address - Street 1:9180 PINECROFT DR STE 100
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-367-6836
Practice Address - Fax:281-367-5545
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7331174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4754569-014OtherCIGNA
TX5621502OtherAETNA PPO
TX113215106Medicaid
TX31892OtherAMERICAID
TX3231889OtherAETNA HMO
TX4754569-012OtherCIGNA
TX4754569-013OtherCIGNA
TX8J1224OtherBCBS
TXP00063148OtherMEDICARE RAILROAD
TXP43964651OtherMULTIPLAN
TXP00063148OtherMEDICARE RAILROAD
TX8A6658Medicare ID - Type UnspecifiedMEDICARE