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Mara Beth Antonoff

Thoracic Surgery (Cardiothoracic Vascular Surgery)

Allopathic & Osteopathic Physicians

1515 Holcombe Blvd, Houston, TX 77030-4000

PECOS Enrollment

This provider is enrolled in PECOS as MARA ANTONOFF.

Based on the most recent information from CMS, provider Mara Beth Antonoff is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1679784839
Provider Type
Individual
Full Name
Antonoff, Mara Beth
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
5/26/2007
Last Updated
8/15/2019

Contact Information

Practice Location

1515 Holcombe Blvd, Houston, TX 77030-4000

(713) 792-6161

Unlisted Fax

Mailing Location

PO Box 4439, Houston, TX 77210-4439

(713) 792-2991

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 208G00000X Primary	Description Thoracic Surgery (Cardiothoracic Vascular Surgery) Allopathic & Osteopathic Physicians	License Q0728 Texas

Provider Identifiers

ID	Description	Issuer
ID 8EQ604	Description Other	Issuer BCBS Texas
ID 339044501	Description Medicaid	Issuer Unlisted Texas

Mara Beth Antonoff

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

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