Provider Demographics
NPI:1104803360
Name:OORJITHAM, EDWARD G (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:G
Last Name:OORJITHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 N ED CAREY DR
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-9204
Mailing Address - Country:US
Mailing Address - Phone:956-440-8020
Mailing Address - Fax:956-440-8131
Practice Address - Street 1:1205 N ED CAREY DR
Practice Address - Street 2:SUITE 2C
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-9204
Practice Address - Country:US
Practice Address - Phone:956-440-8020
Practice Address - Fax:956-440-8131
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139228404Medicaid
TX45D0957184OtherCLIA
0018DFOtherBC/BS