Provider Demographics
NPI:1922635630
Name:DU, INA THEODORA (MD)
Entity Type:Individual
Prefix:
First Name:INA
Middle Name:THEODORA
Last Name:DU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 EL PASEO ST APT 629
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3046
Mailing Address - Country:US
Mailing Address - Phone:860-804-6011
Mailing Address - Fax:
Practice Address - Street 1:1885 EL PASEO ST APT 629
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-3046
Practice Address - Country:US
Practice Address - Phone:860-804-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program