Provider Demographics
NPI:1104871953
Name:GIORGBERIDZE, IRAKLI (MD)
Entity type:Individual
Prefix:DR
First Name:IRAKLI
Middle Name:
Last Name:GIORGBERIDZE
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 1:6550 FANNIN ST STE 1723
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2747
Mailing Address - Country:US
Mailing Address - Phone:713-799-1610
Mailing Address - Fax:713-799-1558
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1723
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-799-1610
Practice Address - Fax:713-799-1558
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1705207RC0001X
MA217421207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S9520OtherBLUE CROSS BLUE SHIELD
TX00W600Medicare PIN
TX00438RMedicare PIN
TX8S9520OtherBLUE CROSS BLUE SHIELD
TX8D8834Medicare ID - Type UnspecifiedMEDICARE NUMBER
TXI40916Medicare UPIN
TXP00259031Medicare ID - Type UnspecifiedMEDICARE RAILROAD NUMBER