Basic Information
| Provider Information | |||||||||
| NPI: | 1578795209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAREDIA | ||||||||
| FirstName: | SALIM | ||||||||
| MiddleName: | NOORJIBHAI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 FROSTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133386353 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11800 ASTORIA BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770896041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819296184 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2009 | ||||||||
| LastUpdateDate: | 03/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N3865 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036122471 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | N3865 | TX | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 206969201 | 05 | TX | MEDICAID | 8CD946 | 01 | TX | BC/BS | OTHER |