Provider Demographics
NPI:1780799171
Name:NORTHWOODS PEDIATRIC CENTER, PA
Entity type:Organization
Organization Name:NORTHWOODS PEDIATRIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHZAD
Authorized Official - Middle Name:ISLAM
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-296-7770
Mailing Address - Street 1:25214 BOROUGH PARK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3519
Mailing Address - Country:US
Mailing Address - Phone:281-296-7770
Mailing Address - Fax:281-296-9777
Practice Address - Street 1:25214 BOROUGH PARK DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3519
Practice Address - Country:US
Practice Address - Phone:281-296-7770
Practice Address - Fax:281-296-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK-1481208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0924573 03Medicaid