Healthcare Provider Details

I. General information

NPI: 1033151428
Provider Name (Legal Business Name): .SUNSTAR GERIATRICS HEALTHCARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S AUSTIN AVE SUITE 1320
GEORGETOWN TX
78626-5610
US

IV. Provider business mailing address

501 S AUSTIN AVE SUITE 1320
GEORGETOWN TX
78626-5610
US

V. Phone/Fax

Practice location:
  • Phone: 512-868-9078
  • Fax: 512-819-0646
Mailing address:
  • Phone: 512-868-9078
  • Fax: 512-819-0646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberK9039
License Number StateTX

VIII. Authorized Official

Name: DR. MARYANN M CHOI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 512-868-9078