Provider Demographics
NPI:1730105925
Name:TAWADROUS, BASSEM SAFWAT (MD)
Entity Type:Individual
Prefix:
First Name:BASSEM
Middle Name:SAFWAT
Last Name:TAWADROUS
Suffix:
Gender:M
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 281181
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1181
Mailing Address - Country:US
Mailing Address - Phone:281-487-2371
Mailing Address - Fax:281-487-3689
Practice Address - Street 1:4600 FAIRMONT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3337
Practice Address - Country:US
Practice Address - Phone:281-487-2371
Practice Address - Fax:281-487-3689
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3495207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194530501Medicaid
TX194530501Medicaid
TXP00771139Medicare PIN
TX8L20265Medicare PIN
TXI19979Medicare UPIN