Provider Demographics
NPI:1649404724
Name:DERMATOLOGY ASSOCIATES OF SUGAR LAND PLLC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF SUGAR LAND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-797-6171
Mailing Address - Street 1:7515 S MAIN
Mailing Address - Street 2:770
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4537
Mailing Address - Country:US
Mailing Address - Phone:717-797-6171
Mailing Address - Fax:713-797-6669
Practice Address - Street 1:2225 WILLIAMS TRACE BLVD
Practice Address - Street 2:112
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4440
Practice Address - Country:US
Practice Address - Phone:281-313-0006
Practice Address - Fax:281-265-3393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOA5901Medicare PIN