Healthcare Provider Details

I. General information

NPI: 1184048449
Provider Name (Legal Business Name): ANUPAM MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 PLAINVIEW ST
PASADENA TX
77504-1906
US

IV. Provider business mailing address

PO BOX 1666
LA MARQUE TX
77568-1666
US

V. Phone/Fax

Practice location:
  • Phone: 409-539-9921
  • Fax:
Mailing address:
  • Phone: 409-539-9921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM5532
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberM5532
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberM5532
License Number StateTX

VIII. Authorized Official

Name: ASHU SODHI SYAL
Title or Position: CLINICAL DIRECTOR
Credential: MD
Phone: 409-539-9921