Healthcare Provider Details

I. General information

NPI: 1609215342
Provider Name (Legal Business Name): ADI GINZBURG M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2013
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 FANNIN ST
HOUSTON TX
77030-1501
US

IV. Provider business mailing address

6431 FANNIN ST
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-5800
  • Fax:
Mailing address:
  • Phone: 713-500-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP1-0054723
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125063655
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number290807-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: