Provider Demographics
NPI:1881990786
Name:CAPITAL INFECTIOUS DISEASE ASSOCIATES
Entity type:Organization
Organization Name:CAPITAL INFECTIOUS DISEASE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-703-9990
Mailing Address - Street 1:P.O. BOX 16461
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496
Mailing Address - Country:US
Mailing Address - Phone:832-886-4994
Mailing Address - Fax:800-559-8401
Practice Address - Street 1:6903 BRISBANE CT STE 100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6845
Practice Address - Country:US
Practice Address - Phone:832-886-4994
Practice Address - Fax:800-559-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4903207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN4903OtherTX LICENSE NUMBER