Provider Demographics
NPI:1790130573
Name:BROWNSVILLE INFECTIOUS DISEASE PA
Entity Type:Organization
Organization Name:BROWNSVILLE INFECTIOUS DISEASE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARLINGTON
Authorized Official - Middle Name:
Authorized Official - Last Name:UDEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-525-7817
Mailing Address - Street 1:110 UPTOWN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7563
Mailing Address - Country:US
Mailing Address - Phone:956-525-7817
Mailing Address - Fax:956-525-7800
Practice Address - Street 1:110 UPTOWN AVE STE B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7563
Practice Address - Country:US
Practice Address - Phone:956-525-7817
Practice Address - Fax:956-525-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN5444OtherSTATE LICENSE
TX3637977-01Medicaid