Provider Demographics
NPI:1467422956
Name:GANDHI, NITA S (MD)
Entity Type:Individual
Prefix:DR
First Name:NITA
Middle Name:S
Last Name:GANDHI
Suffix:
Gender:F
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:PO BOX 891445
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77289-1445
Mailing Address - Country:US
Mailing Address - Phone:713-436-3637
Mailing Address - Fax:713-436-3639
Practice Address - Street 1:9721 BROADWAY ST STE 111
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8170
Practice Address - Country:US
Practice Address - Phone:713-436-3637
Practice Address - Fax:713-436-3639
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1818208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172252201Medicaid
TX172252202Medicaid
TX106343008Medicaid
TX172252202Medicaid
TX172252201Medicaid