Healthcare Provider Details

I. General information

NPI: 1083850176
Provider Name (Legal Business Name): HANNA CHARLES EADEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FANNIN ST DEPT. OF EMERGENCY MEDICINE
HOUSTON TX
77030-2703
US

IV. Provider business mailing address

6565 FANNIN ST DEPT. OF EMERGENCY MEDICINE
HOUSTON TX
77030-2703
US

V. Phone/Fax

Practice location:
  • Phone: 713-790-3333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0109140
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ6504
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: