Provider Demographics
NPI:1366555039
Name:ROONGTA, SURESH MANOHARLAL (MD)
Entity type:Individual
Prefix:DR
First Name:SURESH
Middle Name:MANOHARLAL
Last Name:ROONGTA
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 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 1440
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-791-9119
Mailing Address - Fax:713-791-9199
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 1440
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-791-9119
Practice Address - Fax:713-791-9199
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2426174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00F05WMedicare PIN