Provider Demographics
NPI:1003946542
Name:PHATAK, DARSHAN R (MD)
Entity Type:Individual
Prefix:
First Name:DARSHAN
Middle Name:R
Last Name:PHATAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 BRAESWOOD PARK DR
Mailing Address - Street 2:APARTMENT #221
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4454
Mailing Address - Country:US
Mailing Address - Phone:713-796-6776
Mailing Address - Fax:
Practice Address - Street 1:1885 OLD SPANISH TRAIL
Practice Address - Street 2:HARRIS COUNTY MEDICAL EXAMINER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-796-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223427207ZF0201X
TXM4445207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology