Provider Demographics
NPI:1154370914
Name:PELINI, SUSAN E (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:PELINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 JOHN FREEMAN BLVD
Mailing Address - Street 2:JJLS80
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1088
Mailing Address - Country:US
Mailing Address - Phone:713-500-6700
Mailing Address - Fax:713-500-6722
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:832-325-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049052207R00000X
TXN1831207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BZ715OtherBCBSTX
OH0628315Medicaid
TX201723801Medicaid
OH0628315Medicaid
TX8BZ715OtherBCBSTX
TXF09115Medicare UPIN
OH0586883Medicare ID - Type Unspecified