Provider Demographics
NPI:1740602580
Name:VIPEDIATRX, PA
Entity Type:Organization
Organization Name:VIPEDIATRX, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY-NASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-504-9889
Mailing Address - Street 1:2001 KIRBY DR
Mailing Address - Street 2:810
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-6043
Mailing Address - Country:US
Mailing Address - Phone:832-504-9889
Mailing Address - Fax:832-460-4241
Practice Address - Street 1:2001 KIRBY DR
Practice Address - Street 2:810
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-6043
Practice Address - Country:US
Practice Address - Phone:832-504-9889
Practice Address - Fax:832-460-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM66982080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty