Provider Demographics
NPI:1083861231
Name:EMERALD PEDIATRIC CLINIC PA
Entity Type:Organization
Organization Name:EMERALD PEDIATRIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-444-7726
Mailing Address - Street 1:11511 VETERANS MEMORIAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-2613
Mailing Address - Country:US
Mailing Address - Phone:281-444-7726
Mailing Address - Fax:281-444-9426
Practice Address - Street 1:11511 VETERANS MEMORIAL DR STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-2603
Practice Address - Country:US
Practice Address - Phone:281-444-7726
Practice Address - Fax:281-444-9426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1093811432OtherIND NPI