Provider Demographics
NPI:1891907531
Name:INFECTIOUS DISEASES & TRAVEL MEDICINE SPECIALIST PA
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES & TRAVEL MEDICINE SPECIALIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-251-7888
Mailing Address - Street 1:PO BOX 504257
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-0001
Mailing Address - Country:US
Mailing Address - Phone:281-251-7888
Mailing Address - Fax:281-251-4222
Practice Address - Street 1:12025 LOUETTA RD
Practice Address - Street 2:#B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1149
Practice Address - Country:US
Practice Address - Phone:281-215-7888
Practice Address - Fax:281-251-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDJ2723174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149813101Medicaid
TXF27639Medicare UPIN
TX00675RMedicare ID - Type Unspecified