| D V Listengarten Md Pllc | |
|
8550 Huebner Rd San Antonio TX 78240 | |
| (210) 541-5300 | |
| Not Available |
| Full Name | D V Listengarten Md Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 8550 Huebner Rd, San Antonio, Texas |
| Authorized Official Name and Position | Dmitry V Listengarten (OWNER) |
| Authorized Official Contact | 7138592978 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| D V Listengarten Md Pllc 10004 Wurzbach Rd 332 San Antonio TX 78230 Ph: (713) 859-2978 | D V Listengarten Md Pllc 8550 Huebner Rd San Antonio TX 78240 Ph: (210) 541-5300 |
| NPI Number | 1902274269 |
|---|---|
| Provider Enumeration Date | 09/03/2015 |
| Last Update Date | 09/03/2015 |
| Medicare PECOS PAC ID | 1850692740 |
|---|---|
| Medicare Enrollment ID | O20151218000063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902274269 | NPI | - | NPPES |
| 212157603 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | M0152 (Texas) | Primary |
| Provider Name | Dmitry V Listengarten |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669433173 PECOS PAC ID: 4486680931 Enrollment ID: I20100622000086 |
| Provider Name | Reginald Graves |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801348321 PECOS PAC ID: 7810269578 Enrollment ID: I20170816001392 |
| Provider Name | Kerry Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871027904 PECOS PAC ID: 3173888369 Enrollment ID: I20180516002727 |
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