1912943788 NPI number — GHYASUDDIN SYED M.D

Table of content: GHYASUDDIN SYED M.D (NPI 1912943788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912943788 NPI number — GHYASUDDIN SYED M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SYED
Provider First Name:
GHYASUDDIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912943788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4810 N PINE BROOK WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77059-3160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-422-5500
Provider Business Mailing Address Fax Number:
281-422-5560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2802 GARTH RD
Provider Second Line Business Practice Location Address:
SUITE # 109
Provider Business Practice Location Address City Name:
BAYTOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77521-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-422-5500
Provider Business Practice Location Address Fax Number:
281-422-5560
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  L3493 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: L3493 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8J3390 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10000935 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 160479501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7442412 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com