Provider Demographics
NPI:1265489603
Name:DIPP, SUSANA LAURA (MD)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:LAURA
Last Name:DIPP
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 1:1804 PERSIMMON AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2345
Mailing Address - Country:US
Mailing Address - Phone:617-780-8979
Mailing Address - Fax:
Practice Address - Street 1:1804 PERSIMMON AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2345
Practice Address - Country:US
Practice Address - Phone:617-780-8979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202054207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAI16709Medicare UPIN