Healthcare Provider Details

I. General information

NPI: 1780799171
Provider Name (Legal Business Name): NORTHWOODS PEDIATRIC CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25214 BOROUGH PARK DR
SPRING TX
77380-3519
US

IV. Provider business mailing address

25214 BOROUGH PARK DR
SPRING TX
77380-3519
US

V. Phone/Fax

Practice location:
  • Phone: 281-296-7770
  • Fax: 281-296-9777
Mailing address:
  • Phone: 281-296-7770
  • Fax: 281-296-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK-1481
License Number StateTX

VIII. Authorized Official

Name: SHAHZAD ISLAM SHAH
Title or Position: PRESIDENT
Credential: M.D
Phone: 281-296-7770