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NPI Code Detail

MEDICARE: MARYAM TAGHADOSI MD PA DBA, PARK PLAZA PEDIATRICS

MEDICARE: MARYAM TAGHADOSI MD PA DBA, PARK PLAZA PEDIATRICS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianJ5128TX

General Provider Information

NPI Number : 1578988903
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARYAM TAGHADOSI MD PA DBA, PARK PLAZA PEDIATRICS
Provider Business Mailing Address
First Line : 1213 HERMANN DR STE 770
Second Line :
City : HOUSTON
State : TX
Zip : 77004-7031
Country : US
Telephone Number : 713-807-8921
Fax Number : 713-529-6195
Provider Business Practice Location Address
First Line : 1213 HERMANN DR STE 770
Second Line :
City : HOUSTON
State : TX
Zip : 77004-7031
Country : US
Telephone Number : 713-807-8921
Fax Number : 713-529-6195
Authorized Official
Title or Position : PRESIDENT
Name : MARYAM TAGHADOSI
Credential :
Telephone Number : 832-545-7464
Provider Enumeration Date : 02/21/2014
Last Update Date : 03/13/2014

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