Provider Demographics
NPI:1669494563
Name:NEPHROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAHZEB
Authorized Official - Middle Name:RAZA
Authorized Official - Last Name:NAQVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-813-8074
Mailing Address - Street 1:1120 MEDICAL PLAZA DRIVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:832-813-8074
Mailing Address - Fax:832-813-8076
Practice Address - Street 1:1120 MEDICAL PLAZA DRIVE
Practice Address - Street 2:SUITE 310
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:832-813-8074
Practice Address - Fax:832-813-8076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RN0300X
KYM1968207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H48481Medicare UPIN