MEDICARE: PASADENA DERMATOLOGY CLINIC, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CP7295	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083613962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASADENA DERMATOLOGY CLINIC, P.A.

Provider Business Mailing Address
First Line	:	1020 PASADENA BLVD
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77506-4700
Country	:	US
Telephone Number	:	713-477-8183
Fax Number	:	713-477-8187

Provider Business Practice Location Address
First Line	:	1020 PASADENA BLVD
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77506-4700
Country	:	US
Telephone Number	:	713-477-8183
Fax Number	:	713-477-8187

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDWARD M SHAPIRO
Credential	:	M.D.
Telephone Number	:	713-477-8183

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	05/13/2008

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Directions to “PASADENA DERMATOLOGY CLINIC, P.A. ” Practice Location

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