Provider Demographics
NPI:1487603148
Name:GENDI, WAGIH A (MD)
Entity type:Individual
Prefix:MR
First Name:WAGIH
Middle Name:A
Last Name:GENDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1430 PASADENA BLVD
Mailing Address - Street 2:# A
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-2414
Mailing Address - Country:US
Mailing Address - Phone:713-477-0400
Mailing Address - Fax:713-477-2711
Practice Address - Street 1:1430 PASADENA BLVD
Practice Address - Street 2:#A
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-2414
Practice Address - Country:US
Practice Address - Phone:713-477-0400
Practice Address - Fax:713-477-2711
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ9680208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133436904Medicaid
TXG18123Medicare UPIN