Provider Demographics
NPI:1770596736
Name:NOUREDDINE, GHASSAN A (MD)
Entity type:Individual
Prefix:
First Name:GHASSAN
Middle Name:A
Last Name:NOUREDDINE
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 973722
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-3722
Mailing Address - Country:US
Mailing Address - Phone:713-795-5155
Mailing Address - Fax:713-795-5515
Practice Address - Street 1:6550 FANNIN ST STE 2321
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2723
Practice Address - Country:US
Practice Address - Phone:713-795-5155
Practice Address - Fax:713-795-5515
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9248207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131115108Medicaid
TX131115107Medicaid
TX1396723896OtherBLUE CROSS BLUE SHIELD
TXJ9248OtherLICENSE
TX8B2760Medicare PIN
TX131115108Medicaid
TX131115107Medicaid