Provider Demographics
NPI:1144229634
Name:HART, SUZANNE B (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:B
Last Name:HART
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 1:9191 BLUEBONNET BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2810
Mailing Address - Country:US
Mailing Address - Phone:225-769-2003
Mailing Address - Fax:225-767-3055
Practice Address - Street 1:9191 BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2810
Practice Address - Country:US
Practice Address - Phone:225-769-2003
Practice Address - Fax:225-767-3055
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023104208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1499943Medicaid
LA1499943Medicaid
LAH00510Medicare UPIN