Provider Demographics
NPI:1558333872
Name:BACHA, FIDA F (MD)
Entity Type:Individual
Prefix:DR
First Name:FIDA
Middle Name:F
Last Name:BACHA
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 1:1100 BATES AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2600
Mailing Address - Country:US
Mailing Address - Phone:713-798-7164
Mailing Address - Fax:
Practice Address - Street 1:1100 BATES AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2600
Practice Address - Country:US
Practice Address - Phone:713-798-7164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421405174400000X
TXP1044208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068098EB0Medicare ID - Type Unspecified
PAH80090Medicare UPIN
PA000961936Medicare ID - Type Unspecified