Provider Demographics
NPI:1548372808
Name:DHALA, ATIYA
Entity type:Individual
Prefix:DR
First Name:ATIYA
Middle Name:
Last Name:DHALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1601
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-5141
Mailing Address - Fax:713-790-6470
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1601
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-5141
Practice Address - Fax:713-790-6470
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45835207RC0200X, 207RP1001X
NY224339-1207RP1001X
TXL3280207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02356370Medicaid
TX8GD863OtherBCBS
TX354500602Medicaid
TX354500601Medicaid
TX8FS544OtherBLUE CROSS BLUE SHIELD
NY02356370Medicaid
TX8FS544OtherBLUE CROSS BLUE SHIELD