Provider Demographics
NPI:1790749513
Name:WINCHELL, SUSAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:WINCHELL
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 1:101 AVENUE F N
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-3167
Mailing Address - Country:US
Mailing Address - Phone:979-245-2008
Mailing Address - Fax:979-314-7164
Practice Address - Street 1:2112 REGIONAL MEDICAL DR STE 1313
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-1413
Practice Address - Country:US
Practice Address - Phone:979-543-2956
Practice Address - Fax:979-543-6756
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1428208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126192709Medicaid
TX126192702Medicaid
TX126192705Medicaid
TX8DE550OtherBC/BS #
TX82C337Medicare ID - Type Unspecified
TX126192702Medicaid
TXTXB150850Medicare PIN