Provider Demographics
NPI:1902274269
Name:D V LISTENGARTEN MD PLLC
Entity type:Organization
Organization Name:D V LISTENGARTEN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:V
Authorized Official - Last Name:LISTENGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-859-2978
Mailing Address - Street 1:10004 WURZBACH RD
Mailing Address - Street 2:332
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230
Mailing Address - Country:US
Mailing Address - Phone:713-859-2978
Mailing Address - Fax:
Practice Address - Street 1:8550 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-541-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM01522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212157603Medicaid
TX212157603Medicaid