Provider Demographics
NPI:1114133394
Name:BAYSHORE PEDIATRICS
Entity Type:Organization
Organization Name:BAYSHORE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROMMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-944-2324
Mailing Address - Street 1:4024 BROOKHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1902
Mailing Address - Country:US
Mailing Address - Phone:713-944-2324
Mailing Address - Fax:
Practice Address - Street 1:4024 BROOKHAVEN AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1902
Practice Address - Country:US
Practice Address - Phone:713-944-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149430402Medicaid
TX111822602Medicaid
TX111822604Medicaid
TX1118222601Medicaid
TX149430401Medicaid
TX1118222601Medicaid