Individual
MARA BETH ANTONOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4000
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
Q0728
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339044501
—
TX
01
—
8EQ604
BCBS
TX
Enumeration date
05/26/2007
Last updated
08/15/2019
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