Healthcare Provider Details

I. General information

NPI: 1881639029
Provider Name (Legal Business Name): MARIANA M. TAWADROUS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANA M. AGAIBY D.O.

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 E TRINITY MILLS RD STE 250
CARROLLTON TX
75006-1946
US

IV. Provider business mailing address

2340 E TRINITY MILLS RD STE 250
CARROLLTON TX
75006-1946
US

V. Phone/Fax

Practice location:
  • Phone: 469-620-0811
  • Fax: 940-222-2720
Mailing address:
  • Phone: 469-620-0811
  • Fax: 940-222-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR4484
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: