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General NPI Number Information
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NPI Number | 1184048449
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Entity Type | Organization
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Legal Business Name | ANUPAM MD PA
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Dates
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Enumeration Date | 02/07/2014
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Last Update Date | 10/31/2014
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Provider Practice Location Address
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Address Line | 3320 PLAINVIEW ST
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City | PASADENA
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State | TX
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Zip | 77504-1906
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Country | US
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Telephone | 409-539-9921
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1666
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City | LA MARQUE
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State | TX
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Zip | 77568-1666
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Country | US
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Telephone | 409-539-9921
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | ASHU SODHI SYAL
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Credential | MD
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Telephone | 409-539-9921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | M5532
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | M5532
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | M5532
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License Number State | TX
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