Provider Demographics
NPI:1912090317
Name:CHARAFEDDINE, NIZAR CHAFIC (MD)
Entity Type:Individual
Prefix:
First Name:NIZAR
Middle Name:CHAFIC
Last Name:CHARAFEDDINE
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 272486
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77277
Mailing Address - Country:US
Mailing Address - Phone:713-439-8166
Mailing Address - Fax:713-436-8168
Practice Address - Street 1:2813 SMITH RANCH ROAD
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:713-436-8166
Practice Address - Fax:913-436-8168
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036145783207RG0100X
OH35.141601207RG0100X
TXK6821207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030278801Medicaid
TX030278801Medicaid
00421MMedicare ID - Type Unspecified
TX00421MMedicare PIN