Provider Demographics
NPI:1114056058
Name:NUSRAT B SOLEJA MD PA
Entity Type:Organization
Organization Name:NUSRAT B SOLEJA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NUSRAT
Authorized Official - Middle Name:B
Authorized Official - Last Name:SOLEJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-935-9800
Mailing Address - Street 1:PO BOX 57668
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7668
Mailing Address - Country:US
Mailing Address - Phone:409-935-9800
Mailing Address - Fax:409-935-9802
Practice Address - Street 1:6417 MEMORIAL DR
Practice Address - Street 2:STE A
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-4058
Practice Address - Country:US
Practice Address - Phone:409-935-9800
Practice Address - Fax:409-935-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0111PUOtherBCBSTX
TXDE0969OtherRR MEDICARE
TX179000801Medicaid
TX00W021Medicare PIN