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General NPI Number Information
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NPI Number | 1033151428
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Entity Type | Organization
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Legal Business Name | .SUNSTAR GERIATRICS HEALTHCARE PA
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | 501 S AUSTIN AVE SUITE 1320
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City | GEORGETOWN
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State | TX
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Zip | 78626-5610
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Country | US
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Telephone | 512-868-9078
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Fax | 512-819-0646
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Provider Business Mailing Address
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Address Line | 501 S AUSTIN AVE SUITE 1320
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City | GEORGETOWN
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State | TX
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Zip | 78626-5610
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Country | US
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Telephone | 512-868-9078
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Fax | 512-819-0646
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. MARYANN M CHOI
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Credential | M.D.
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Telephone | 512-868-9078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | K9039
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License Number State | TX
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