Provider Demographics
NPI:1255411591
Name:ELENBERG, EWA (MD)
Entity type:Individual
Prefix:
First Name:EWA
Middle Name:
Last Name:ELENBERG
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 1:6701 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2316
Mailing Address - Country:US
Mailing Address - Phone:832-824-3800
Mailing Address - Fax:832-825-3889
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2316
Practice Address - Country:US
Practice Address - Phone:832-824-3800
Practice Address - Fax:832-825-3889
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK24552080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119035704Medicaid
TX119035704Medicaid
TX8936M4Medicare PIN
TX8A0132Medicare PIN
TXTXB121253Medicare PIN
TX8L0301Medicare PIN