Provider Demographics
NPI:1013023472
Name:TAYLOR, SUSAN DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DIANE
Last Name:TAYLOR
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 1:2014 GENERAL PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-5436
Mailing Address - Country:US
Mailing Address - Phone:504-899-2885
Mailing Address - Fax:
Practice Address - Street 1:1401 FOUCHER ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3515
Practice Address - Country:US
Practice Address - Phone:504-897-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020685207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1969001Medicaid
LAP00682234OtherRAILROAD MCARE THRU PEPA
LA1969001Medicaid
LA5R709CQ60Medicare PIN
LA1969001Medicaid