MEDICARE: GHASSAN A NOUREDDINE M.D.

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	207RP1001X	Pulmonary Disease Physician	J9248	TX
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	J9248	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1396723896	OTHER	TX	BLUE CROSS BLUE SHIELD
4	J9248	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1770596736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHASSAN A NOUREDDINE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 973722
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75397-3722
Country	:	US
Telephone Number	:	713-795-5155
Fax Number	:	713-795-5515

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST STE 2321
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2723
Country	:	US
Telephone Number	:	713-795-5155
Fax Number	:	713-795-5515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	10/31/2022

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Directions to “ GHASSAN A NOUREDDINE M.D.” Practice Location

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