Provider Demographics
NPI:1245225002
Name:BATRA, DIPESH (MD)
Entity Type:Individual
Prefix:
First Name:DIPESH
Middle Name:
Last Name:BATRA
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 1:5800 BELLAIRE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5537
Mailing Address - Country:US
Mailing Address - Phone:713-668-8900
Mailing Address - Fax:713-668-8903
Practice Address - Street 1:5800 BELLAIRE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5537
Practice Address - Country:US
Practice Address - Phone:713-668-8900
Practice Address - Fax:713-668-8903
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86843208000000X
TXN3487208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211135304Medicaid
TX211135301Medicaid
TX211135302Medicaid
FL267350900Medicaid
B90778Medicare UPIN
FLU1077Medicare ID - Type Unspecified