Provider Demographics
NPI:1093916140
Name:GLORIOSO, SARAH E (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:E
Last Name:GLORIOSO
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 1:2300 HOSPITAL DR.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2180
Mailing Address - Country:US
Mailing Address - Phone:318-212-7800
Mailing Address - Fax:318-212-7802
Practice Address - Street 1:2300 HOSPITAL DR.
Practice Address - Street 2:SUITE 400
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2180
Practice Address - Country:US
Practice Address - Phone:318-212-7800
Practice Address - Fax:318-212-7802
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201108207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA21683Medicaid