Provider Demographics
NPI:1891779450
Name:HUTCHINS, SUSAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:D
Last Name:HUTCHINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:D
Other - Last Name:LACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:909 FROSTWOOD DR STE 1.100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9250 PINECROFT DR # N2.101
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:713-897-5539
Practice Address - Fax:713-897-2275
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4278208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100940902Medicaid
TX110176910OtherRR MEDICARE PIN
TX110176910OtherRR MEDICARE PIN
F66737Medicare UPIN
TX100940902Medicaid
TX87E468Medicare PIN