Provider Demographics
NPI:1902095995
Name:NINAN T. MATHEW, M.D., P.A.
Entity Type:Organization
Organization Name:NINAN T. MATHEW, M.D., P.A.
Other - Org Name:HOUSTON HEADACHE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:F
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-528-1916
Mailing Address - Street 1:1213 HERMANN DR
Mailing Address - Street 2:SUITE 820
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7018
Mailing Address - Country:US
Mailing Address - Phone:713-528-1916
Mailing Address - Fax:713-526-6369
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:SUITE 820
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:713-528-1916
Practice Address - Fax:713-526-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00943YMedicare PIN