Provider Demographics
NPI:1326198813
Name:JAMES ALEXANDER GHADIALLY MD PA
Entity type:Organization
Organization Name:JAMES ALEXANDER GHADIALLY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:GHADIALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-528-3901
Mailing Address - Street 1:3262 WESTHEIMER RD
Mailing Address - Street 2:SUITE 313
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1002
Mailing Address - Country:US
Mailing Address - Phone:713-528-3901
Mailing Address - Fax:713-528-4592
Practice Address - Street 1:10926 EAST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-1912
Practice Address - Country:US
Practice Address - Phone:713-528-3901
Practice Address - Fax:713-528-4592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6513207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0099NJOtherBCBS GROUP
TX00855ZMedicare ID - Type UnspecifiedHOUSTON GROUP #
TX00856ZMedicare ID - Type UnspecifiedBEAUMONT GROUP