Provider Demographics
NPI:1356570220
Name:ABU ATHERAH, EMRAN ABDUL (MD)
Entity type:Individual
Prefix:
First Name:EMRAN
Middle Name:ABDUL
Last Name:ABU ATHERAH
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 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-724-8180
Mailing Address - Fax:281-336-1171
Practice Address - Street 1:600 N KOBAYASHI STE 208
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4841
Practice Address - Country:US
Practice Address - Phone:281-724-8180
Practice Address - Fax:281-336-1171
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3135207R00000X, 207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201223850Medicaid
TX8EZ612OtherBCBS
KY7100278520Medicaid
KYP01287191OtherRAILROAD MEDICARE
TXQ3135OtherMEDICAL LICENSE
TX407664ZL0WMedicare Oscar/Certification
KYK118260Medicare Oscar/Certification