Provider Demographics
NPI:1285045195
Name:BINAYAO, MAHTA ROUHANI (MD)
Entity Type:Individual
Prefix:
First Name:MAHTA
Middle Name:ROUHANI
Last Name:BINAYAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAHTA
Other - Middle Name:
Other - Last Name:ROUHANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12221 RENFERT WAY STE 330
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5374
Mailing Address - Country:US
Mailing Address - Phone:713-756-8374
Mailing Address - Fax:
Practice Address - Street 1:12221 RENFERT WAY STE 330
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:512-425-3825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10051200207V00000X
390200000X
TXR6888207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8JT560OtherBCBS TEXAS