Provider Demographics
NPI:1447268974
Name:MEDLEY, HANSA BEN (MD)
Entity type:Individual
Prefix:MRS
First Name:HANSA
Middle Name:BEN
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HANSA
Other - Middle Name:BHAKTI
Other - Last Name:MEDLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3920 BRAXTON DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-6304
Mailing Address - Country:US
Mailing Address - Phone:713-782-2156
Mailing Address - Fax:713-782-5054
Practice Address - Street 1:3920 BRAXTON DR
Practice Address - Street 2:SUITE 108
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-6304
Practice Address - Country:US
Practice Address - Phone:713-782-2156
Practice Address - Fax:713-782-5054
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB138621Medicare PIN
TXF67556Medicare UPIN
TX00L09HMedicare ID - Type Unspecified