MEDICARE: MARTHA MAE SISSA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	P7229	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H08QY07301	OTHER	TX	BCBS OF TEXAS
2	1790929040	OTHER	TX	BCBS OF TEXAS
3	1790929040	OTHER	TX	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1790929040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA MAE SISSA M.D.

Provider Business Mailing Address
First Line	:	8540 BROADWAY ST STE 205
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7710
Country	:	US
Telephone Number	:	832-582-7146
Fax Number	:	832-962-8154

Provider Business Practice Location Address
First Line	:	8540 BROADWAY ST STE 205
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7710
Country	:	US
Telephone Number	:	832-582-7146
Fax Number	:	832-962-8154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	09/15/2025

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