Provider Demographics
NPI:1386795078
Name:PANZARELLA, SUSAN K
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:PANZARELLA
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 1:9652 FM 1960 BYPASS RD W
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4039
Mailing Address - Country:US
Mailing Address - Phone:281-446-7771
Mailing Address - Fax:281-446-7701
Practice Address - Street 1:9652 FM 1960 BYPASS RD W
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4039
Practice Address - Country:US
Practice Address - Phone:281-446-7771
Practice Address - Fax:281-446-7701
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0012233332B00000X
332BP3500X
TX0072935332BX2000X
TX335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531601OtherBLUE CROSS BLUE SHIELD
TX531483OtherBLUE CROSS BLUE SHIELD
TNV16521OtherHOMELINK
TNV16521OtherHOMELINK