Provider Demographics
NPI:1679653091
Name:RAINE, SUSAN P (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:RAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4775
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4775
Mailing Address - Country:US
Mailing Address - Phone:713-798-1978
Mailing Address - Fax:713-798-1188
Practice Address - Street 1:6620 MAIN ST
Practice Address - Street 2:SUITE 1450
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2348
Practice Address - Country:US
Practice Address - Phone:713-798-7500
Practice Address - Fax:713-798-3487
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2028207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175418602Medicaid
TX8D7728Medicare PIN
TX175418602Medicaid
TX8L2787Medicare PIN
TX8D8231Medicare PIN