Provider Demographics
NPI:1952318727
Name:GUILLORY, CHARLETA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLETA
Middle Name:
Last Name:GUILLORY
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 1:6621 FANNIN ST # B.06140
Mailing Address - Street 2:MC WT 6-104
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2303
Mailing Address - Country:US
Mailing Address - Phone:832-826-1379
Mailing Address - Fax:832-825-2799
Practice Address - Street 1:6621 FANNIN ST # B.06140
Practice Address - Street 2:MC WT 6-104
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-826-1379
Practice Address - Fax:832-826-1379
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG10242080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXGU089976FMedicare ID - Type Unspecified
TXE12379Medicare UPIN