Provider Demographics
NPI:1659356616
Name:SOLEJA, NUSRAT B (MD)
Entity Type:Individual
Prefix:
First Name:NUSRAT
Middle Name:B
Last Name:SOLEJA
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 57668
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7668
Mailing Address - Country:US
Mailing Address - Phone:409-935-9800
Mailing Address - Fax:409-935-9802
Practice Address - Street 1:6417 MEMORIAL DR
Practice Address - Street 2:STE A
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-4058
Practice Address - Country:US
Practice Address - Phone:409-935-9800
Practice Address - Fax:409-935-9802
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ7680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132553208Medicaid
TX8AD981OtherBCBSTX
TXP00271498OtherRR MEDICARE
TX8F2097Medicare PIN
TXF94691Medicare UPIN