Provider Demographics
NPI:1356651244
Name:MATHEW, SUSAN (M D)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16659 SOUTHWEST FWY STE 235
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2372
Mailing Address - Country:US
Mailing Address - Phone:281-980-2717
Mailing Address - Fax:281-265-3806
Practice Address - Street 1:1429 HIGHWAY 6 STE 209
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-5135
Practice Address - Country:US
Practice Address - Phone:832-500-1395
Practice Address - Fax:832-500-1399
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA195387174400000X
TXP8156207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX392210YN34OtherMEDICARE
TX348750603Medicaid
TX392210ZL0WOtherMEDICARE
TX8HY593OtherBLUE CROSS BLUE SHIELD