Healthcare Provider Details

I. General information

NPI: 1619363595
Provider Name (Legal Business Name): GHAZALEH ESKANDARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 BERTNER AVE. (CHI BAYLOR ST. LUKE'S MEDICAL CENTER
HOUSTON TX
77030
US

IV. Provider business mailing address

ONE BAYLOR PLAZA #286A
HOUSTON TX
77030-3411
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-4661
  • Fax: 713-798-5838
Mailing address:
  • Phone: 832-516-5905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberS9294
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: