Provider Demographics
NPI:1922491448
Name:PEDIATRIC CARDIOLOGY CARE PA
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-648-3000
Mailing Address - Street 1:711 W BAY AREA BLVD
Mailing Address - Street 2:SUITE 625
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4043
Mailing Address - Country:US
Mailing Address - Phone:281-648-3000
Mailing Address - Fax:281-648-3001
Practice Address - Street 1:711 W BAY AREA BLVD
Practice Address - Street 2:SUITE 625
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4043
Practice Address - Country:US
Practice Address - Phone:281-648-3000
Practice Address - Fax:281-648-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty