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General NPI Number Information
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NPI Number | 1467560029
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Entity Type | Individual
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Provider Name | TODD ANTHONY MARAIST MD
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 4421 HWY 6 SOUTH STE 100
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City | COLLEGE STATION
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State | TX
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Zip | 77845
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Country | US
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Telephone | 979-690-4470
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Fax | 979-690-4471
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Provider Business Mailing Address
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Address Line | 17200 ST LUKES WAY STE 100
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City | THE WOODLANDS
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State | TX
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Zip | 77384-8007
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Country | US
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Telephone | 936-266-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 0101273994
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | H6405
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License Number State | TX
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Taxonomy #3
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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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