Provider Demographics
NPI:1962490052
Name:BERBERIAN, ESTEBAN N (MD)
Entity Type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:N
Last Name:BERBERIAN
Suffix:
Gender:M
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:PO BOX 1939
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-1939
Mailing Address - Country:US
Mailing Address - Phone:281-247-8020
Mailing Address - Fax:281-247-8026
Practice Address - Street 1:15201 EAST FWY STE 103
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-4137
Practice Address - Country:US
Practice Address - Phone:281-247-8020
Practice Address - Fax:281-247-8026
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8002207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030730802Medicaid