Healthcare Provider Details

I. General information

NPI: 1154370914
Provider Name (Legal Business Name): SUSAN E PELINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST 600
HOUSTON TX
77030-3000
US

IV. Provider business mailing address

1133 JOHN FREEMAN BLVD JJLS80
HOUSTON TX
77030-1088
US

V. Phone/Fax

Practice location:
  • Phone: 832-325-7100
  • Fax:
Mailing address:
  • Phone: 713-500-6700
  • Fax: 713-500-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35049052
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN1831
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: