Provider Demographics
NPI:1467673301
Name:PCP ASSOCIATES OF PASADENA PA
Entity Type:Organization
Organization Name:PCP ASSOCIATES OF PASADENA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTANAIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-943-8229
Mailing Address - Street 1:4102 WOODLAWN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504
Mailing Address - Country:US
Mailing Address - Phone:713-943-8229
Mailing Address - Fax:713-943-9608
Practice Address - Street 1:4102 WOODLAWN AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504
Practice Address - Country:US
Practice Address - Phone:713-943-8229
Practice Address - Fax:713-943-9608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0096CVOtherBCBS OF TX
TX00367KMedicare ID - Type Unspecified