Provider Demographics
NPI:1245453570
Name:STEVAN L. DINERSTEIN, M.D.P.A.
Entity type:Organization
Organization Name:STEVAN L. DINERSTEIN, M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DINERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-793-7550
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 2204
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-793-7550
Mailing Address - Fax:713-793-7555
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 2204
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-793-7550
Practice Address - Fax:713-793-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0883174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1639353Medicaid
TX0976565Medicaid
TX00375VMedicare ID - Type UnspecifiedMEDICARE GROUP NO
TX0976565Medicaid