Provider Demographics
NPI:1598997256
Name:EDIONWE, SUSAN OMWANGHE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:OMWANGHE
Last Name:EDIONWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7707 FANNIN ST
Mailing Address - Street 2:SUITE 195
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1926
Mailing Address - Country:US
Mailing Address - Phone:713-797-0045
Mailing Address - Fax:713-797-1821
Practice Address - Street 1:7707 FANNIN ST
Practice Address - Street 2:SUITE 195
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1926
Practice Address - Country:US
Practice Address - Phone:713-797-0045
Practice Address - Fax:713-797-1821
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ4943207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10173OtherEMPLOYEE IDENTIFICATION NUMBER