Provider Demographics
NPI:1467523886
Name:ELGHETANY, MOHAMED TAREK (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:TAREK
Last Name:ELGHETANY
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:6621 FANNIN STREET
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY, TCH, SUITE WB 1100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:832-824-5122
Mailing Address - Fax:832-825-5110
Practice Address - Street 1:6621 FANNIN STREET
Practice Address - Street 2:TEXAS CHILDREN'S HOSPITAL DEPARTMENT OF PATHOLOGY
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-824-5122
Practice Address - Fax:832-825-5110
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH2356207ZP0105X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118289104Medicaid
TX118289104Medicaid
TXTXB116467Medicare PIN
F91149Medicare UPIN
TX83298NMedicare ID - Type Unspecified