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General NPI Number Information
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NPI Number | 1245410018
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Entity Type | Organization
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Legal Business Name | ANDREW B CIVITELLO MD PA
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 05/25/2010
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Provider Practice Location Address
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Address Line | 1200 BINZ ST SUITE 1290
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City | HOUSTON
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State | TX
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Zip | 77004-6900
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Country | US
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Telephone | 713-526-8900
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Fax | 713-526-8901
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Provider Business Mailing Address
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Address Line | 1200 BINZ ST SUITE 1290
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City | HOUSTON
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State | TX
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Zip | 77004-6900
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Country | US
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Telephone | 713-526-8900
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Fax | 713-526-8901
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ALICE CATHY CIVITELLO
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Credential | PA-C
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Telephone | 713-526-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | K4661
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License Number State | TX
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