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General NPI Number Information
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NPI Number | 1184801177
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Entity Type | Organization
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Legal Business Name | TODD A. MARAIST, MD
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 1105 UNIVERSITY DR E STE 100
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City | COLLEGE STATION
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State | TX
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Zip | 77840-2183
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Country | US
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Telephone | 979-846-4100
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Fax | 979-846-4118
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Provider Business Mailing Address
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Address Line | 1105 UNIVERSITY DR E STE 100
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City | COLLEGE STATION
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State | TX
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Zip | 77840-2183
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Country | US
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Telephone | 979-846-4100
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Fax | 979-846-4118
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Authorized Official
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Title or Position | OWNER
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Name | DR. TODD A MARAIST
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Credential | MD
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Telephone | 979-846-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 09505
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | H6405
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License Number State | TX
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