MEDICARE: DR. SUSAN PHAN CARPINTEYRO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	R4453	TX
2	207Q00000X	Family Medicine Physician	R4453	TX

General Provider Information

NPI Number	:	1922428994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN PHAN CARPINTEYRO M.D.

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PKWY
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	23960 KATY FWY STE 140
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-0892
Country	:	US
Telephone Number	:	713-464-9939
Fax Number	:	713-464-9942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	12/09/2025

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