Provider Demographics
NPI:1669589958
Name:GHATTAS, NOSHI B (MD)
Entity type:Individual
Prefix:DR
First Name:NOSHI
Middle Name:B
Last Name:GHATTAS
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 1:1605 ROCK PRAIRIE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8358
Mailing Address - Country:US
Mailing Address - Phone:979-693-4461
Mailing Address - Fax:979-696-1358
Practice Address - Street 1:1605 ROCK PRAIRIE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8358
Practice Address - Country:US
Practice Address - Phone:979-693-4461
Practice Address - Fax:979-696-1358
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2701207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22959Medicare UPIN
TX00K39QMedicare ID - Type Unspecified
TX88T640Medicare PIN