Provider Demographics
NPI:1447200308
Name:ABU SHARIFEH, TAREQ MOH'D ALI (MD)
Entity Type:Individual
Prefix:
First Name:TAREQ
Middle Name:MOH'D ALI
Last Name:ABU SHARIFEH
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1167
Mailing Address - Country:US
Mailing Address - Phone:409-747-9163
Mailing Address - Fax:409-747-9327
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-1167
Practice Address - Country:US
Practice Address - Phone:409-747-9163
Practice Address - Fax:409-747-9327
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8253207RC0000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166276901Medicaid
TXP00467136OtherRR MEDICARE
TX1447200308OtherBCBS OF TX
TX8X6789OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX166276903Medicaid
TX1447200308OtherTRICARE
TXP00467136OtherRR MEDICARE
TX8J9005Medicare PIN
TX760010407OtherTIN
TX1447200308OtherTRICARE
TX166276903Medicaid
TX1447200308OtherBCBS OF TX