MEDICARE: HANISSIAN PEDIATRICS, PLLC

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	208000000X	Pediatrics Physician	H8677	TX

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	:	1083627103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANISSIAN PEDIATRICS, PLLC

Provider Business Mailing Address
First Line	:	9809 ROWLETT RD
Second Line	:	SUITE A1
City	:	HOUSTON
State	:	TX
Zip	:	77075-3403
Country	:	US
Telephone Number	:	713-644-1119
Fax Number	:	713-644-0900

Provider Business Practice Location Address
First Line	:	9809 ROWLETT RD
Second Line	:	SUITE A1
City	:	HOUSTON
State	:	TX
Zip	:	77075-3403
Country	:	US
Telephone Number	:	713-644-1119
Fax Number	:	713-644-0900

Authorized Official
Title or Position	:	PEDIATRICIAN
Name	:	DR. TALYNN A HANISSIAN
Credential	:	M.D.
Telephone Number	:	713-644-1119

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	01/10/2017

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