Provider Demographics
NPI:1265694863
Name:AZITA MADJIDI MD MS PA
Entity type:Organization
Organization Name:AZITA MADJIDI MD MS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AZITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADJIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-797-1000
Mailing Address - Street 1:6624 FANNIN STREET
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2328
Mailing Address - Country:US
Mailing Address - Phone:713-797-1000
Mailing Address - Fax:
Practice Address - Street 1:6624 FANNIN STREET
Practice Address - Street 2:SUITE 1600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2328
Practice Address - Country:US
Practice Address - Phone:713-797-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty