Provider Demographics
NPI:1184048449
Name:ANUPAM MD PA
Entity type:Organization
Organization Name:ANUPAM MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHU
Authorized Official - Middle Name:SODHI
Authorized Official - Last Name:SYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-539-9921
Mailing Address - Street 1:PO BOX 1666
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-1666
Mailing Address - Country:US
Mailing Address - Phone:409-539-9921
Mailing Address - Fax:
Practice Address - Street 1:3320 PLAINVIEW ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1906
Practice Address - Country:US
Practice Address - Phone:409-539-9921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5532261Q00000X, 261QM1300X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193755901Medicaid
TX3352759-03Medicaid
TX4876619Medicaid
TX3352759-01Medicaid
TX3352759-02Medicaid
TX1124064779OtherPROVIDER NPI