Provider Demographics
NPI:1912263021
Name:CLEAR LAKE PEDIATRIC NEPHROLOGY, P.A.
Entity Type:Organization
Organization Name:CLEAR LAKE PEDIATRIC NEPHROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-557-7308
Mailing Address - Street 1:2803 HARVEST HILL CT
Mailing Address - Street 2:AUTUMN CREEK
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5099
Mailing Address - Country:US
Mailing Address - Phone:281-557-7308
Mailing Address - Fax:
Practice Address - Street 1:400 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4235
Practice Address - Country:US
Practice Address - Phone:281-338-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric NephrologyGroup - Single Specialty